Resp & Qualifications
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.
- Supports the QI infrastructure necessary to improve the quality and safety of clinical care and services;
- Collaborates with functional leads throughout the organization to assure compliance with regulatory and accreditation requirements;
- Uses performance data from quality measurement and QI activities to improve the quality and safety of clinical care and services provided to CareFirst members;
- Analyzes and evaluates the effectiveness of quality measurement and activities to identify and prioritize process improvements and gaps in care ; and
- Utilizes results from population based quality and satisfaction measurement to inform quality improvement interventions for 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.
- Maintains knowledge of current accreditation, regulatory and healthcare quality, clinical practices, and quality measurement requirements and standards;
- Monitors compliance to accreditation and regulatory requirements and engages functional leaders to support quality efforts;
- Collaborates with functional leads to collect and analyze quality assessments for all aspects of plan operations, clinical care, network adequacy, experience of care and safety;
- Oversees performance of Delegated functions/ Vendor activities;
- Analyzes processes, audit results and data trends to identify and prioritize opportunities;
- Utilizes lessons learned and industry best practices to drive improvement; and
- Coordinates, facilitates, document s and reports on all aspects of assigned project(s).
3. Leads quality improvement teams
- Coordinates and leads QI related committees and/or work teams;
- Conducts both quantitative and qualitative analysis to identify priorities;
- Analyzes processes, results and trends to recommend actions and assist with implementation of strategies that drive continual improvement;
- Documents and reports all aspects of assigned project(s) using project plans and work plans for tracking; and
- Creates executive level and front line reports and presentations.
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.
- Leads an interdisciplinary oversight committee charged with monitoring delegated activities throughout the organization;
- Oversees ongoing assessments of delegated activities to assure compliance with regulatory and accreditation requirements; and
- Collaborates with trusted partners to close gaps in care, improve access, and improve health and operational outcomes.
- Any of the following: Bachelor’s Degree or other advanced degree in healthcare related field or equivalent experience.
- 2+ years of professional experience in business environment (healthcare, public health, health insurance, quality/process improvement or data management);
- Training or certification in Quality or Process Improvement Methods, preferred – or related training in an analytic field, including engineering, public health, or data science;
- Proven capacity to perform qualitative and quantitative data analyses and create innovative strategies and work with colleagues to address findings; and
- Ability to learn the technical aspects of collection and reporting of both administrative and clinical aspects of quality measures.
- Excellent verbal and written communications;
- Must be a critical thinker who uses sound judgment in the evaluation of performance throughout the organization;
- Must possess data fluency and be skilled in analyzing and presenting data;
- Broad knowledge of the healthcare industry including both clinical and operational aspects of Health Insurance Plan and products (preferred but not required); and
- Able to motivate people and influence change in a complex organization.
Department: Accreditation & Medical Programs
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: 7/31/2018
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