Resp & Qualifications
CareFirst BlueCross BlueShield (CareFirst), is the Mid-Atlantic region’s largest health plan, covering the healthcare needs of 3.4 million members. With the implementation of its Patient Centered Medical Home (PCMH) Program, CareFirst is a national leader in clinical innovation and quality programs. The company’s Total Care and Cost Improvement (TCCI) Programs support members along the care continuum, as they progress through various stages of health and illness. The program’s core is to provide incentives, health data, infrastructure, and resources that promote high quality, cost effective health care for members. This model has proven success since inception in 2011; there have been 19% fewer hospital admissions, 15% fewer days spent in hospitals, 20% fewer hospital readmissions for all causes, and reduced medical costs for patients covered by the PCMH program.
The Quality Specialist is part of a team responsible for helping to ensure that our 3.4 million members receive the highest quality care and service possible. This individual, in collaboration with others across the organization, is responsible for quality measurement collection and will use data to identify opportunities and work throughout the organization to implement quality improvement interventions.
This individual champions quality improvement across the company .Through relationships will key leads throughout the organization, they carry out the QI Program goals and objectives leading to compliance with regulatory and accreditation requirements and progressively increasing health plan performance.
This individual is a part of a team of quality professionals to achieve the triple aim: improving health outcomes, reducing cost of care and improving the overall experience for members; as well as, physician satisfaction through the following:
1) Carries out the region-wide quality improvement (QI) program;
2) Collects, analyzes and reports on mandated quality assessments;
3) Leads Quality Improvement teams; and
4) Monitors and collaborates with delegated/contracted partners to assure alignment with plan and regulatory standards.
Under the direct supervision of the Manager, Clinical Innovations, this associate’s accountabilities include, but are not limited to, the following:
1. Carries out the corporate QI program
The Quality Specialist, utilizes healthcare knowledge, business acumen and data fluency to drive quality improvement throughout the organization.
2. Collects, analyzes and reports on mandated quality assessment
Through effective relationships throughout the organization, with trusted partners, clinical practices providing care and with external regulators, the CareFirst Quality Specialist assures compliance and drives improvement.
3. Leads quality improvement teams
4. Monitors and collaborates with delegated/contracted partners to assure alignment with plan and regulatory standards
This individual assures that our delegated partners are providing services aligned with our PCMH/TCCI Programs and fully compliant with regulatory and CareFirst standards.
Department: Accreditation & Medical Program
Equal Employment Opportunity
CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.
Hire Range Disclaimer
Actual salary will be based on relevant job experience and work history.
Where To Apply
Please visit our website to apply: www.carefirst.com/careers
Please apply before: 5/17/2018
Federal Disc/Physical Demand
Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.
The physical demands described below are representative of those that must be met by an associate to perform the essential duties and responsibilities of the position successfully. Requirements may be modified to accommodate individuals with disabilities.
The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The employee must frequently talk and hear. Weights of up to 25 pounds are occasionally lifted. Occasional driving is required.
Sponsorship in US
Must be eligible to work in the U.S. without Sponsorship