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Professional - Non-Clinical
Senior Quality Improvement Specialist - Health Plan
Houston, TX, US
We are searching for a Senior Quality Improvement Specialist – someone who works well in a fast-paced setting. In this position, the Senior Quality Improvement Specialist facilitates process improvement. This includes leading process improvement using QI methodology, coordinating quality improvement committees and advisory committees, completing regulatory reporting requirements, leading provider site process improvement, and researching the latest developments in process improvement to ensure TCHP's QI program and work plan are leveraging innovative and high impact interventions. This role will also serve other operational duties to meet the QI needs of Texas Children's Health Plan.
Think you got what it takes?
Skills & Requirements
- Bachelor's degree required
- 3 years in Project management or process/quality improvement experience required
- Licenses/Certifications: Preferred RN - Lic-Registered Nurses Texas Board of Nursing
- Advanced proficiency in Microsoft Excel to analyze data to identify meaningful trends and measure process improvement. Knowledge and Skills
- Intermediate-Advanced proficiency in Microsoft Word, PowerPoint, Access, and MiniTab or another statistical software package
- Intermediate-Advanced skills cross-departmental workgroups with validated QI methodology to drive process improvement in an industry setting
- Intermediate-Advanced proficiency in project management
- Excellent interpersonal or organizational skills necessary to present and communicate important information effectively to all levels of health plan staff
- Knowledge of population health quality measurement standards including but not limited to NCQA’s HEDIS measures, AHRQ’s CAHPS Surveys, and 3M’s PPEs.
Job Duties & Responsibilities
- Establish annual QI work plan for each assigned QI objective. This includes: calculating baseline performance and establishing surrogate markers to measure progress toward aim, developing QI tools to organize and communicate the work plan, completing standard report outs to communicate QI progress to leadership. •
- Lead process improvement workgroups. This includes: building a cross-functional process improvement team, completing cause/effect analyses using internal and external sources, developing key driver diagrams to connect interventions with aim, leading rapid PDSA (plan, do study, act) cycles and pivoting interventions based on outcomes of PDSA
- Based on results of assessments, or observations made while obtaining information, makes recommendations for consideration by Quality leadership team. Presents recommendations orally and in writing in a clear, concise format.
- Uses analysis of documentation and models to create and design new processes and improvements to existing processes.
- Serve as TCHP’s subject matter expert on all technical specifications for assigned HEDIS measures. This includes: ongoing proactive data collection, electronic medical record data integration, administrative data integrity, supplemental data optimization, and medical record review.
- Leverage analytics tools to identify opportunities to close HEDIS gaps to improve overall HEDIS compliant rates
- Lead process improvement at provider sites to support provider’s performance on high impact quality measures and adherence to clinical practice guideline
- Perform appropriate audit in response to quality of care concern. This includes: reviewing providers’ credentialing history, completing public search on provider (i.e. news articles, social media, online postings), requesting patient records, interviewing providers, completing on site audit, develop/summarize findings and present recommendation to medical director
- Lead a corrective action plan for providers who do not meet quality standards. This includes: developing new processes and controls to correct quality of care concern, establishing timelines for completion of corrective action plan, and reporting outcome of corrective action plan to appropriate health plan committee or leadership team.
- Complete regulatory reporting requirements related to oversight of MCO Quality performance
About Texas Children’s
Founded in 1996, Texas Children’s Health Plan is the nation's first health maintenance organization (HMO) created just for children. We provide STAR/Medicaid and Children's Health Insurance Program (CHIP) to pregnant women, teens, children and adults in Houston and surrounding areas. Currently, the Health Plan has more than 375,000 members who receive care from our network of more than 1,100 primary care physicians, 3,200 specialists, and 70 hospitals. Texas Children's Health Plan is also the largest combined STAR/CHIP Managed Care Organization in the Harris County service area.
To join our community of 14,000+ dedicated team members, visit texaschildrenspeople.org for career opportunities. You can also learn more about our amazing culture at infinitepassion.org.
Texas Children’s is proud to be an equal opportunity employer. All applicants and employees are considered and evaluated for positions at Texas Children's without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, gender identity, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.
