Boise-ID ; Seattle- WA ; Portlan- OR; Burlington- WA; Salt Lake City- UT
Primary Job Purpose
Develops and implements quality improvement programs related to clinical quality measurement and outcomes and assists in resolving deficiencies that impact plan compliance to regulatory accreditation standards and/or quality measurement. Ensures activities meet regulatory requirements of the state or product and reflects Cambia’s quality strategies, approaches and work plans.
At Cambia, our values are fundamental to achieving our Cause of transforming the health care industry. They guide our actions and bring diverse perspectives together to improve the health care journey better for those we serve. All eight values are equally important and linked to the others: Empathy, Hope, Courage, Trust, Commitment, Innovation, and Accountability. These values are not just words on paper - we live them every day.
Responsibilities & Requirements
Competencies and Knowledge:
- Knowledge of quality improvement processes and performance measurement and ability to develop and accomplish clinical quality measurement and/or program activities.
- Demonstrated ability to identify problems, develop solutions and implement a chosen course of action.
- Leadership skills with the ability to direct activities of others both individually and within a project team .
- Ability to organize, plan, prioritize and develop multiple projects within time constraints.
- Strong knowledge and understanding of data integrity/validity standards and significance.
- Ability to perform sound basic quantitative and qualitative analyses and interpretation.
- Knowledge of the healthcare industry, preferably in the managed care market.
- Excellent verbal and written communication skills including ability to communicate effectively across multiple areas and levels.
- Participation in successful NCQA/URAC accreditation process, AND/OR full HEDIS production reporting and continuous process improvement experience preferred.
Required Licenses, Certifications, Registration, Etc.
- Certified Professional in Healthcare Quality (CPHQ) preferred.
- May require a valid state driver’s license.
General Functions and Outcomes
- Develops and maintains required/applicable quality program documents, including a standardized quality management plan and program to ensure compliance with external regulatory and accreditation and/or performance measurement requirements.
- Serves as a point of contact, coordinating and collaborating with accreditation entities and business partners to ensure compliance with accreditation and/or performance measurement requirements. Prepares enterprise for accreditation and/or performance measurement submissions and reviews.
Serves as the subject matter expert for applicable accreditation standards/measurement requirements. Makes recommendations to business unit partners for improvements or remediation to accreditation/reporting compliance/improvement programs.
- Monitors exposure to accreditation/measurement risks and identifies opportunities to manage and mitigate those risks.
- Compiles information related to quality improvement and accreditation monitoring activities for internal use and external audits and maintains relevant records.
- Assists with the development and maintenance of required quality program documents. Responsible for reporting activities to the quality committee and management.
- Responsible for managing and coordinating quality committees, including committee scheduling, workflows, production of contemporaneous committee minutes, reporting and processes in support of the Quality Program.
- Works with clinical and operational areas to develop performance metrics for monitoring program objectives. Identifies areas for improvement and implements interventions or corrective action plans as needed.
- Establishes and maintains tracking and monitoring systems for health quality improvement activities according to regulatory requirements, accreditation standards, policies and procedures and contractual agreements.
- Effectively keeps leaders informed through regular written and verbal project status communications.
At Cambia, we advocate for transforming the health care system. You aren’t satisfied with the status quo and neither are we. We're looking for individuals who are as passionate as we are about transforming the way people experience health care. We offer a competitive salary and a generous benefits package. We are an equal opportunity employer dedicated to workforce diversity and a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A drug screen and background check is required.
Cambia’s portfolio of companies spans health care information technology and software development; retail health care; health insurance plans that carry the Blue Cross and Blue Shield brands; pharmacy benefit management; life, disability, dental, vision and other lines of protection; alternative solutions to health care access; and free-standing health and wellness solutions.
We have nearly a century of experience in developing and providing health solutions to serve our members. We had our beginnings in the logging communities of the Pacific Northwest as innovators in helping workers afford health care. That pioneering spirit has kept us at the forefront as we build new avenues to improve access to and quality of health care for the future.
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Cambia Health Solutions, headquartered in Portland, Oregon, is dedicated to transforming health care. We put people at the heart of everything we do as we work to make the health care system better and more economically sustainable for people and their families. Our company reaches more than 70 [...]