CareFirst Careers

Senior Quality Improvement Specialist

Resp & Qualifications

Company Description:
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 became and has remained a national leader in clinical innovation and quality programs. The company’s Patient Centered Medical Home and Clinical 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.

Duties and Responsibilities

PRINCIPAL ACCOUNTABILITIES:

Define, measure, and improve health plan operations and the member and provider experience, and drive quality improvement initiatives

  • Utilize a variety of quantitative and qualitative analysis methods to assess health plan operations; identify, prioritize, and lead process improvement activities
  • Lead collaborative workgroups with operational and business leaders within and outside the organization to assess and assure quality performance, network adequacy, experience of care, and member safety
  • Use performance data from quality measurement and QI activities to improve the quality and safety of clinical care and services provided to CareFirst members
  • Analyze and evaluate results from member and provider quality and satisfaction surveys to inform quality improvement interventions and improve the “member journey”
  • Develop and present reports, strategies and visual presentations to inform peers and organizational leaders

Use published standards, regulatory requirements, and best practices to ensure companywide accreditation and regulatory compliance

  • Maintain knowledge of current NCQA accreditation and other regulatory and healthcare quality requirements and standards
  • Develop and implement insight-driven, problem-solving approaches to ensure meeting accreditation and regulatory requirements
  • Perform quantitative, qualitative, and barrier analysis of Plan activities, develop and deploy opportunities for improvement
  • Oversee performance of Delegates, delegated functions and vendor activities to ensure compliance with regulatory and accreditation requirements
  • Analyze results of improvement activities, reassess and design new interventions, as indicated
  • Understand and utilize Plan-Do-Study-Act (PDSA) DMAIC, or other recognized quality improvement techniques

Prioritize, develop, and operationalize opportunities in collaboration with other functional areas of the organization into innovative programs and interventions

 

QUALIFICATION REQUIREMENTS:
Education/Experience:

  • Bachelor’s degree in business administration, health policy, health services research, public health, economics, mathematics, computer science, or a related field; In lieu of Bachelor’s Degree, must have 4 years related experience.
  • 4+ years of professional experience in a business environment (public health, health insurance, management consulting fields preferred); evidence of progressing levels of responsibility.
  • Demonstrated expertise in the creation of qualitative and quantitative data analyses and analytic presentations
  • Demonstrated success in driving process improvement in a matrix environment
  • Experience designing, developing, and implementing innovative strategies to improve healthcare or other similarly complex, regulated systems
  • Experience self-managing multiple projects and provide regular status reports
  • Experience presenting to and working with executive-level leaders
  • Experience managing others and assisting with their day-to-day needs

    Preferred:

  • Experience and knowledge with accreditation survey process to include NCQA, HEDIS, and CAHPS
  • Experience in health plans
  • Lean Six Sigma Green Belt (or higher) certification
  • Project Management Professional (PMP) certification

     

    Abilities/Skills:

  • Superb strategic, analytic, problem solving, and communication skills
  • Able to learn the technical aspects of collection and reporting of quality measures
  • Strong teamwork and interpersonal skills, an ability to present and discuss information in a way that establishes rapport, persuades others, and gains understanding
  • Comfortable with ambiguity and able to set your own direction
  • Strong project management and organizational skills
  • Must be able to effectively work in a fast-paced environment with frequently changing priorities, deadlines, and workloads that can be variable for long periods of time. Must be able to meet established deadlines and handle multiple project demands from internal and external partners. Must be able to effectively communicate and build strong relationships with every internal and external partner, including partners who may be demanding or otherwise challenging.

     

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

Closing Date

Please apply before: 8/24/2020

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.

PHYSICAL DEMANDS:

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 associate must frequently talk and hear.  Weights up to 25 pounds are occasionally lifted.

Sponsorship in US

Must be eligible to work in the U.S. without Sponsorship

Learn more about Medical Management