Quality Performance Specialist Clinical - Quality ...

Your career starts now. We''re looking for the next generation of health care leaders.At AmeriHealth Caritas, we''re passionate about helping people get care, stay well and build healthy communities. As one of the nation''s leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we''d like to hear from you.Headquartered in Philadelphia, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more about us at Responsibilities:The Clinical Quality Performance Specialist is responsible for leading and managing the clinical quality review process. With a focus on ensuring standards of care are met, this position is poised to lead improvement efforts through data analysis, provider partnership, and program development. This role is for individuals who thrive in the complexity of the healthcare environment, yet ready to be part of the systemic change needed to ensure quality and equity in care are connected and aligned. This role has flexibility to work outside of regular business hours. Primary Responsibilities include but are not limited to: • Lead and manage the clinical quality review process. • Assist in Quality Management initiatives including data collection and analysis• Participate in activities to maintain compliance with state regulations and NCQA standards for quality activities• Participate in the implementation of clinical and service quality improvement studies and performance improvement initiatives • Supporting the annual medical record review activities including HEDIS and, Clinical Practice Guidelines. Education/ Training:• Bachelor''s Degree in a healthcare related field (preferred) • 3-5 years [clinical] healthcare experience (require)• 2 years quality improvement experience (preferred)License/Certification/Registration• RN License (District of Columbia) Knowledge, Skills, and Abilities• Effective verbal and written communication skills. • High degree of computer proficiency, particularly Microsoft Office applications: Word, PowerPoint, Excel • Ability to establish priorities in a fast-paced and innovative environment, work independently, self-motivated, goal oriented, and solution focused. • Experience in project facilitation and management; preferred• Knowledge and understanding of QI functions in an MCO; preferred.• DC residency preferred BackShareApply Now

Created: 2021-11-29