Quality Improvement Specialist

Quality Improvement Specialist

The Health Plan of San Mateo (HPSM), a managed care health plan, seeks a full time Quality Improvement Specialist who is responsible for leading the intervention planning process from start to finish including planning, implementation, monitoring progress and evaluating effectiveness. Support a culture of continuous quality improvement by identifying opportunities. Key areas of focus for improvement efforts may include but are not limited to Healthcare Effectiveness and Data Information Set (HEDIS) performance, performance on Quality Withhold measures, member experience & health outcomes (CAHPS & HOS surveys), Culturally & Linguistically Appropriate Services (CLAS) Program and HPSM's Population Health Management (PHM) Program.

The essential duties and responsibilities will include the following: 

• Conduct assessments and analysis of data related to quality improvement topics(s) to identify opportunities for improvement and inform intervention planning process. Make recommendations based on findings.
• Develop, implement, monitor and evaluate interventions and improvement activities to increase quality performance as measured by nationally standardized benchmarks and definitions.
• Lead intervention planning process and develop evaluations plans
• Perform analysis to determine statistically significant trends in the data compared to industry standards, recognized benchmarks and baseline data.
• Monitor and ensure the validity of data, utilize data systems to generate, manipulate and analyze data for all assigned topics.
• Identify barriers and facilitators to performance improvement for assigned topics.
• Evaluate, monitor, and report on intervention status and effectiveness measures on a quarterly basis
• Create process documentation and workflows for intervention and performance improvement activities.
• Establish/maintain relationships with local and community partners with the aim of promoting evidence-based care.
• Lead and/or participate in internal and external meetings, workgroups and coalitions related to quality improvement programs and interventions.
• Partner with Health Promotion team to ensure health promotion and/or cultural and linguistic considerations are applied during the planning process and to all intervention related member materials.
• Participate in member experience and CLAS efforts within the organization.
• Work collaboratively with other HPSM departments or clinical staff (e.g. provider services, marketing pharmacy and Care Coordination) to develop interventions and measure outcomes.
• Provide physician office staff orientation to QI programs including promoting evidence-based care and familiarizing physician office staff to the support activities provided by HPSM.
• Work directly with provider offices to increase performance on quality indicators and practice improvement; request information from physician and other providers’ offices
• Perform other duties as assigned.

Requirements

Education and Experience:

• Bachelor’s Degree in in Public Health, Health Education/Promotion, Epidemiology, or a related field required.  Master of Public Health (MPH) or other advanced degree strongly preferred.
• Three (3) years of experience in healthcare quality improvement, healthcare delivery systems, project management or program development and evaluation. Experience with Medi-Cal and Medicare programs/members preferred.

Knowledge of:

• Personal computers and proficiency in Microsoft Office Suite applications, including Outlook, Word, Excel, Access and PowerPoint.
• Thorough knowledge of the principles and methods of research methodology, statistical analysis and report design (preferred).
• Strong knowledge of HEDIS reporting.
• Strong knowledge of Medicare and Star ratings (strongly preferred).
• Strong understanding of relational databases.
• The concepts of managed health care.
• Title 22 regulations (preferred).

Ability to:

• Work cooperatively with others.
• Work as part of a team and support team decisions.
• Communicate effectively, both verbally and in writing.
• Adapt to changes in requirements/priorities for daily and specialized tasksEvaluate medical records and other health care data.
• Plan, organize and lead data collection activities.
• Resolve simple and/or complex analytical problems.
• Present statistical and technical data in a clear and understandable manner utilizing appropriate visual aids.
• Effectively facilitate and coordinate the work of a workgroup engaged in quality improvement activities.
• Establish and maintain effective and cooperative working relationship with HPSM staff and others contacted in the course of the work.
• Maintain accurate records and confidentiality of sensitive medical information.
• Assume responsibility and exercise good judgment in making decisions within the scope of authority of the position.
• Accurately complete tasks within established times and to effectively prioritize multiple tasks and deadlines.

Compensation and Benefits

Starting Compensation Range: - Depending on Experience

Benefits Information: Excellent benefits package offered, including HPSM paid premiums for employee’s Medical, Dental and Vision coverage.  Employee pays a small portion of the dependent premiums (5%) for medical and dental benefits.  Additional HPSM benefits include fully paid life, AD&D, and LTD insurance; retirement plan (HPSM contributes equivalent of 10% of annual compensation); holiday and vacation pay; tuition reimbursement plan; onsite fitness center and more.