Job Summary:
The Healthcare Quality Implementations & Integrations Specialist supports the Quality function of new business market and product implementations and integrations through reviewing and understanding current and prospective contracts and informing content for proposals, including identifying, collecting and managing documentation required for responses to Requests for Proposals (RFPs) and other business-related proposals. This role will serve as a Quality liaison between Enterprise Implementation Organization, Enterprise Project Management Organization and the Quality & Performance Organization.
Essential Functions:
Partner with the Quality sub-functions, IT and IMO to ensure the successful on-time delivery and operational readiness of sustainable business solutions, including appropriate Epic and Feature development, related to the implementation of new markets/products and the integration of new CSMS affiliates.
Draft governing documents (QI Program Description, work plan, charters, and policies & procedures) for desktop readiness reviews and Go-Live readiness for new market/product implementations and integrations of new CSMS affiliates.
Drive continuous quality improvement by incorporating innovative approaches and lessons learned into implementation processes and deliverables.
Build and maintain effective relationships with internal and external stakeholders to facilitate collaboration and successful project outcomes.
Assist other Quality & Performance Outcome teams with EQRO and NCQA readiness.
Review pre-work and in-flight RFP opportunities and advise proposal writers in the content development in response to RFP requirements.
Review and analyze cross-functional data needed to support RFP and other proposal requirements.
Develop and maintain repositories for quality related data, including internal and external data.
Complete groundwork requirements, such as, but not limited to, evaluating state or federal priorities, performing market research and completing epidemiological studies.
Review current and prospective contracts, work cross functionally with other SMEs and writers to collect required supplemental documentation, appendices and forms.
Proofread proposal documents and make revisions, as necessary.
Complete Modelof Care SNP documentation such as Population Assessment and Quality Improvement requirements.
Support proposal compliance efforts through compiling success stories and metrics for RFP content inclusion.
Collect proposal commitments related to quality improvement and work cross-functionally to implement.
Support other quality functional areas in the development and execution of new market and product implementations.
Performs any other job related duties as requested.
Perform any other job related duties as requested.
Education and Experience:
Bachelor's degree required
Equivalent years of relevant work experience may be accepted in lieu of required education
Five (5) years of Managed Care experience, preferably within Quality Management/Improvement required
Competencies, Knowledge and Skills:
Proficiency in Microsoft Office tools, including Power point, Word, Excel, Teams and Outlook
Demonstrates effective listening, critical thinking skills; analytical and timely in problem solving skills
Demonstrates interpersonal and relationship building skills
Ability to effectively interact with all levels within the organization
Demonstrates effective written and verbal communication skills
Strong knowledge of Managed Care and Quality Management, including NCQA accreditations
Ability to work independently and with within a team environment
Detail-oriented with strong organizational and time management abilities
Licensure and Certification: Current CPHQ certification preferred
Working Conditions:
General office environment; may be required to sit or stand for extended periods of time
Up to 15% (occasional) travel based on the needs of the department may be required
Compensation Range:
$72,200.00 - $115,500.00CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.
Compensation Type(hourly/salary):
SalaryOrganization Level Competencies
Fostering a Collaborative Workplace Culture
Cultivate Partnerships
Develop Selfand Others
Drive Execution
Influence Others
Pursue PersonalExcellence
Understand the Business
This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.
Brand=CareSourceOriginally posted on Himalayas