JOB SUMMARY

Responsible for implementing processes in the Quality Improvement department regarding project management, and quality improvement within a managed care organization. Responsibilities include monitoring, tracking, trending, analyzing, and reporting all data, performance measures, and other required information requested by the Health and Human Services Commission (HHSC), Centers for Medicare and Medicaid Services (CMS), Texas Department of Insurance (TDI), or any other accrediting or regulatory bodies. Monitors data and action plans as they relate to projects/programs overseen by the Quality Improvement department. The current projects include but are not limited to HHSC Performance Improvement Projects, HHSC Pay for Quality, Quality Rating System (QRS) Quality Improvement Strategy, Health Plan Accreditation, HEDIS project and HHSC QAPI. Contributes to the design of new or to refine existing initiatives to increase Provider/Member/Partners engagement and improve outcomes. Coordinates cross functional efforts internally and externally as needed to support assigned projects. Supports the department with the collection and analysis of related data/information and in the development of strategies/processes to improve performance outcomes.

JOB SPECIFICATIONS AND CORE COMPETENCIES

Responsible for tracking, trending, analyzing, and reporting all data, performance measures, and other required information requested by Health and Human Services Commission (HHSC), Centers for Medicare and Medicaid Services (CMS), Texas Department of Insurance (TDI) or any other accrediting or regulatory bodies. Ensuring all deliverables deadlines are met for the Health and Human Services Commission (HHSC), Texas Department of Insurance (TDI), and any other regulatory bodies.

Monitors data and implements action plans as they relate to projects/programs overseen by the Quality Improvement department. The current projects include but are not limited to the Health and Human Services Commission (HHSC) Performance Improvement Projects, Health, and Human Services (HHSC) Pay for Quality, Quality Health Plan (QHP), Quality Improvement Strategy, Health Plan Accreditation, HEDIS project and HHSC QAPI project.

Assist in the design of new or to refine existing initiatives to increase Provider/Member/Partners engagement and improve outcomes on assigned projects/programs.

Responsible for obtaining metrics/data from the Health and Human Services Commission (HHSC), and external contractors and/or internal partners that relate to assigned projects/programs. Collects, and analyzes, related data/information and assist in the development of strategies/processes to improve performance outcomes.

Actively contributes to achievement of departmental goals, as identified in Departments annual business plan, including specific departmental process improvement plans and other duties as assigned.


MINIMUM QUALIFICATIONS:

Education/Specialized Training/Licensure: Bachelor of Art (BA) in business, Social Work, Health Care, Project Management, or related field required.

Masters degree preferred.

Work Experience (Years and Area): 3 years of managed care, health care, or related experience; with a minimum of one year being in Quality Improvement or Project Management.

Software Proficiencies: Microsoft Office (Word, Outlook, Excel)