Quality Program Strategist II

This is a fully remote position, open to applicants in Florida.

📋 Description

• Analyze market trends and manage quality improvement initiatives for HEDIS, CAHPS, and/or HOS strategies.

• Identify stakeholder business challenges and propose solutions that enhance business value.

• Examine business challenges, develop hypotheses, and validate conclusions to find effective solutions.

• Conduct assessments for HEDIS gap closure, performance in CAHPS and/or HOS, pilot projects, and process enhancements.

• Review measure specifications, performance trends, stakeholder inputs, literature, initiatives, policies, procedures, and resources.

• Utilize data analysis to extract actionable insights and develop strategic recommendations.

• Work in partnership with markets and business stakeholders to enhance measure performance.

• Create support resources and tools for HEDIS, CAHPS, and/or HOS.

• Evaluate health plan requirements and collaborate with cross-functional teams on strategic projects.

• Ensure compliance with state reporting, HHS, and HPMS memos regarding quality ratings.

• Implement quality-check policies and procedures for communication with members and providers.

• Develop QPS policies, procedures, and quality checks for department programs and activities.

• Design, maintain, and conduct training for Quality Improvement Health Plan personnel.

• Carry out other assigned responsibilities.

• Adhere to all policies and standards.

⛳️ Requirements

• Must be a resident of Florida.

• Experience across multiple lines of business.

• Familiarity with Five Why's and/or Fishbone methodologies.

• Bachelor’s degree in Nursing, Public Health, a related field, or equivalent experience is required.

• A minimum of 4 years of clinical, managed care, or health insurance experience is necessary.

• Preferred qualifications include being a Registered Nurse (RN), Licensed Practical Nurse, Licensed Vocational Nurse, or Licensed Clinical Social Worker (LCSW).

• CPHQ certification is preferred.

• A Master’s degree is preferred.

• At least 2 years of quality experience is preferred.

🏝️ Benefits

• Competitive salary.

• Health insurance coverage.

• 401K and stock purchase options.

• Tuition reimbursement programs.

• Paid time off in addition to holidays.

• Flexible work arrangements including remote, hybrid, field, or office schedules.

• Other incentive options may be part of the overall compensation.

• Equal opportunity employer dedicated to fostering diversity.