Description
General Summary of Position
Responsible for implementation, integration and operational direction of the quality improvement program within MedStar Family Choice's (MSFT) Maryland Medicaid operations through organizing and directing the activities of Quality Improvement Services, this includes, but is not limited to, monitoring MFC participating provider processes and outcomes, overseeing the preparation and response for the EQRO and HEDIS audits, acting as the liaison between QI and other departments, and assisting the Medical Director with any State reports and meetings. Will be responsible for developing and executing innovative strategies to ensure VBP(value-based purchasing) targets are met, CAHPS results are above the HealthChoice aggregate, and Maryland Consumer Report Card results are above the HealthChoice average. Will work collaboratively with NCQA Accreditation Project Manager to ensure all standards are met. Oversees MedStar Family Choice's Quality Improvement Program (QIP), completion of the annual assessment of the QIP against external regulations, and MFC's annual operating plan to ensure MFC is in alignment with meeting regulatory requirements and internal goals. Analyzes outcome data to direct activities of Quality Improvement. Oversees MFC's participating provider processes and outcomes, overseeing the preparation and response for the EQRO (external quality review organization) and HEDIS audits, acting as the liaison between QI and other departments, coordination with the Medical Director on reports and meetings for the regulatory agency, and assisting the NCQA project Manager to ensure MFC maintains NCQA accreditation. Oversees and develops departmental goals and ensure alignment with external regulatory requirements and MFC's annual operating plan. Analyzes outcome data to direct outreach activities to achieve all regulatory targets and HEDIS benchmarks within the 75th - 90th percentile. Aligns wellness initiatives with the goals and standards of the local jurisdiction to include Value Based Purchasing, EPSDT and HEDIS standards.
Primary Duties and Responsibilities
Minimum Qualifications
Education
- Bachelor's degree in healthcare field required and
- BSN preferred and
- Master's degree in healthcare field preferred and
- CPHQ certification preferred
Experience
- 3-4 years Quality improvement experience in an outpatient setting and preferable within a Managed Care Organization (MCO), 3 years supervisory experience system development and implementation experience. required and
- 3-4 years supervisory experience; system development and implementation experience required and
- 5-7 years diverse clinical experience required
Licenses and Certifications
- RN - Registered Nurse - State Licensure and/or Compact State Licensure Valid RN license in the local area serving (State of Maryland or District of Columbia) Upon Hire preferred or
- certification in healthcare related field Upon Hire preferred and
- CPHQ - Certified Professional in Healthcare Quality Upon Hire preferred
Knowledge, Skills, and Abilities
- Knowledge of current trends in health care delivery and population management.
- Knowledge of NCQA, HEDIS, EQRO audits and local regulatory guidelines.
- Strong analytical skills, technical writing skills, excellent problem-solving skills and ability to exercise independent judgement.
- Business acumen and leadership skills.
- Strong verbal and written communication skills with ability to effectively interact with all levels of management, internal departments and external agencies.
- Proficient with Microsoft Office applications especially Outlook, Word, Excel and PowerPoint.
- Proficiency with Microsoft Teams and other virtual meeting platforms preferred.
- Ability to enter and retrieve information using a PC.
- Working knowledge of various computer software applications.
Why MedStar Health?
At MedStar Health, we understand that our ability to treat others well begins with how we treat each other. We work hard to foster an inclusive and positive environment where our associates feel valued, connected, and empowered. We live up to this promise through:
- Strong emphasis on teamwork - our associates feel connected to each other and our mission as an organization. In return, our effective team environment generates positive patient outcomes and high associate satisfaction ratings that exceed the national benchmark.
- Strategic focus on equity, inclusion, & diversity - we are committed to equity for all people and communities. We continue to build a diverse and inclusive workplace where people feel a sense of belonging and the ability to contribute to equitable care delivery and improved community health outcomes at all levels of the organization.
- Comprehensive total rewards package - including competitive pay, generous paid time off, great health and wellness benefits, retirement savings, education assistance, and so much more.
- More career opportunities closer to home - as the largest healthcare provider in the Baltimore-Washington, D.C. region, there are countless opportunities to grow your career and fulfill your aspirations.
About MedStar Health
MedStar Health is dedicated to providing the highest quality care for people in Maryland and the Washington, D.C., region, while advancing the practice of medicine through education, innovation, and research. Our team of 32,000 includes physicians, nurses, residents, fellows, and many other clinical and non-clinical associates working in a variety of settings across our health system, including 10 hospitals and more than 300 community-based locations, the largest home health provider in the region, and highly respected institutes dedicated to research and innovation. As the medical education and clinical partner of Georgetown University for more than 20 years, MedStar Health is dedicated not only to teaching the next generation of doctors, but also to the continuing education, professional development, and personal fulfillment of our whole team. Together, we use the best of our minds and the best of our hearts to serve our patients, those who care for them, and our communities. It's how we treat people.
MedStar Health is an Equal Opportunity (EO) Employer and assures equal opportunity for all applicants and employees. We hire people to work in different locations, and we comply with the federal, state and local laws governing each of those locations. MedStar Health makes all decisions regarding employment, including for example, hiring, transfer, promotion, compensation, benefit eligibility, discipline, and discharge without regard to any protected status, including race, color, creed, religion, national origin, citizenship status, sex, age, disability, veteran status, marital status, sexual orientation, gender identity or expression, political affiliations, or any other characteristic protected by federal, state or local EO laws. If you receive an offer of employment, it is MedStar Health's policy to hire its employees on an at-will basis, which means you or MedStar Health may terminate this relationship at any time, for any reason.
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