Quality Improvement Specialist

Alignment Healthcare is a consumer-centric platform delivering customized health care in the United States to seniors and those who need it most, the chronically ill and frail, through its Medicare Advantage plans. Alignment Healthcare provides partners and patients with customized care and service where they need it and when they need it, including clinical coordination, risk management and technology facilitation. Alignment Healthcare offers health plan options through Alignment Health Plan, and also partners with select health plans to help deliver better benefits at lower costs.

By becoming a part of the Alignment Healthcare team, you will provide Medicare enrolled consumers the quality of care they truly need and deserve. We believe that great work comes from people who are inspired to be their best. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment community.

Position Summary:

The Quality Improvement Specialist is responsible for quality improvement activity within the STAR program, including project management, process improvement, campaign coordination, and outcomes measurement.

General Duties/Responsibilities (May include but are not limited to):

· Possess a deep understanding of the Medicare STARS program and assist with implementation and execution of strategy related to the program.

· Coordinate the planning and execution of quality initiatives and HEDIS campaigns for the Medicare STAR program. This may include material development, mailing campaigns, IVR calling campaigns, case review, and other cross-functional initiatives to improve member outcomes.

· Track and report on outcomes and KPI’s for the program to ensure progress is met throughout the various project life cycles using designated operating and project plans.

· Responsible for formulating and executing all processes, requests, workflows, or policies as requested by management in an efficient manner, including offering a proactive approach to suggestions and recommendations.

· Support collecting data from various sources, such as multiple EMR systems, enterprise data warehouse (EDW), command center, and other internal and external data sources.

· Support all aspects of the NCQA HEDIS audit process to ensure accuracy and compliance of this data with applicable policies. i.e. MRR review, review and update data mappings regularly to ensure accuracy, collaborate with data analyst and DTS partners to resolve data issues impacting HEDIS reporting, define requirements for HEDIS-related dashboards, and perform User Acceptance Testing. 

· Use critical thinking skills to solve a wide array of problems and use a solutions-based approach when presenting issues.

· Implement process improvements to streamline departmental functions.

· Preparation of meeting materials or training documentation as needed.

· Ensure patient privacy is protected by adhering to HIPAA standards, company policies and procedures, and other federal, state, and local requirements.

Supervisory Requirements:

There are no supervisory responsibilities.

Minimum Requirements:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.  The requirements listed below are representative of the knowledge, skill, and/or ability required.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

·  Minimum Experience:

a.       Minimum 1-2 years of quality improvement, HEDIS, Medicare STAR program experience required in a health plan, managed care, or medical group/IPA setting.

·  Education/Licensure:

a.       Bachelor’s degree (BA or BS) from four-year college or university in a health-related field (Health Science, Health Administration, or related) required.

·  Other:

1. Proficient in Microsoft Office (Outlook, Microsoft Teams, Excel, Work, PowerPoint required. Visio and Access are preferred) and familiar working with large data sets.
2. Knowledge of medical terminology and HIPAA.
3. Mathematical skills, attention to detail, problem-solving and analytical skills are essential.
4. Self-starter; able to work independently with minimal supervision.
5. Strong communications skills: written, verbal, and interpersonal

·  Work Environment:

1. The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Essential Physical Functions:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.
• The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.

Alignment Healthcare, LLC is proud to practice Equal Employment Opportunity and Affirmative Action. We are looking for diversity in qualified candidates for employment: Minority/Female/Disable/Protected Veteran.

If you require any reasonable accommodation under the Americans with Disabilities Act (ADA) in completing the online application, interviewing, completing any pre-employment testing or otherwise participating in the employee selection process, please contact [email protected].