What are the responsibilities and job description for the Quality Improvement Specialist position at UCare?
Job Description
ABOUT UCARE
UCare offers Medicare, Medicaid, Individual and Family health plans – powered by the hardest working people in the industry. Our people powered teams de-complicate, advocate and always go the extra mile to help our members. We serve with integrity, compassion and commitment to do right by members, providers and government partners. Above all, we come to work excited to provide members a path for the best health of their lives.
WORKING AT UCARE
Working at UCare is more than a career; it's a mission. A mission that defines us as professionals, unites us as an organization and shapes how we interact with our members and each other. Employees join UCare and stay because of the opportunity to have a purpose-driven job.
Our strong culture has established UCare as a Star Tribune Top 200 Workplace for 14 consecutive years since the awards program began. It’s a culture that embraces innovative ideas, strategic partnerships, and exemplary customer and provider experiences. Working at UCare is being a part of a people powered team dedicated to making a real difference in the lives of our members and communities.
Position Description
As a Quality Improvement Specialist, you will be responsible for the design, development, implementation, evaluation and reporting of evidence-based health improvement programs as they relate to UCare’s strategic and annual quality plan. You will be accountable for leading project teams, coordinating and collaborating with internal and external stakeholders, meeting project objectives and reporting to regulatory entities and leadership on project status and outcomes. You will be responsible for all project management and process improvement activities as they relate to designated projects.
- Responsible for project management of complex quality improvement activities. This includes both leading and/or participating as a team member on various projects. Responsible for overseeing and managing project plans, timelines, interventions, quantitative project data, and development of measures to effectively meet the requirements of regulatory agencies and/or UCare’s annual quality plan.
- Develop key deliverables which may include, but are not limited to, regulatory reports, presentations and status updates. Responsible for identifying and addressing project barriers and reporting progress to appropriate UCare leadership.
- Ensure appropriate measurement and data analysis is used for each project. This may include qualitative and quantitative review, barrier analysis of project topic, review of findings as well as actively soliciting provider and member input.
- Participate in ensuring that UCare is compliant with regulatory requirements for quality. This includes an understanding of applicable State, Federal, and NCQA requirements and the ability to keep updated with any new requirements and to modify projects, as needed.
- Serve as an active participant and/or leader in internal and/or external collaborative meetings and work groups as they relate to projects. This includes attending and actively participating in external meetings with regulators, other health plans, community, and stakeholder groups.
- a common project goal. Align outreach and initiatives to target health needs in our diverse membership.
- Provide regulatory quality expertise to external organizations with a business relationship with UCare. This includes oversight for organizations for which UCare has delegated authority or to organizations for which UCare has contractual arrangements for consultation for design and implementation of quality improvement activities.
- d quality improvement goals. This may include communicating UCare’s quality strategy, gathering information on quality initiatives from the provider groups, and providing expertise, tools, and resources as appropriate.
- Align with strategic and departmental goals to develop and support new and ongoing project efforts as they relate to the Quality Improvement team. This includes, but is not limited to, Performance Improvement Projects (PIP), focused studies, delegated quality activities, Pay for Performance strategies, HEDIS, NCQA, delegation oversight, surveys and other quality initiatives.
- Provide education and tools to improve company knowledge of quality improvement and processes. Define appropriate measures of processes and outcomes.
- Maintain knowledge of industry trends and practices.
- Other projects and duties as assigned.
Requirements
Education
Bachelor's degree in business administration, health care, information systems, social sciences, public health or other related field required. Master's and/or nursing degree preferred.
Required Experience
Two years of experience in quality improvement and five or more years of experience in health care delivery system. Demonstrated process improvement and project management skills. Strong verbal and written communication skills.
Preferred Experience
Formal training in quality improvement and/or project management. Education in statistical analysis and experience in a managed care or health insurance setting. NCQA accreditation experience.
THE UCARE DIFFERENCE
The UCare difference is our people power – employees actively working on the behalf of our members to get them access to the health care they need. We value and respect each individual's ideas and contributions, and provide the freedom to grow both personally and professionally. We are centrally located, and offer onsite education, equipment and wellness resources, and a myriad of volunteer activities. If you're looking for an inclusive environment that celebrates your people power, helps you build on your strengths and gives you the opportunity to truly make a difference, we invite you to .
