Quality Program Strategist II

This is a fully remote position, open to applicants in Florida, +3 more states.

📋 Description

• Identify market trends and manage quality enhancement programs for HEDIS, CAHPS, and/or HOS strategies.

• Assist stakeholders in recognizing business challenges and propose solutions to enhance business value.

• Analyze business issues presented by stakeholders, develop hypotheses, and test conclusions to identify solutions.

• Conduct assessments for HEDIS gap closure, CAHPS and/or HOS performance, pilot programs, and process improvements.

• Evaluate technical specifications for measures, performance trends, stakeholders, industry/research literature, organizational initiatives, policies, procedures, and resources/tools.

• Utilize data analysis to generate actionable insights and strategic recommendations.

• Collaborate with markets and key business stakeholders to enhance measure performance.

• Develop support resources and tools for HEDIS, CAHPS, and/or HOS to address gap closure and improve member/provider experience.

• Assess the needs of health plans and work cross-functionally on strategic initiatives.

• Monitor adherence to state reporting, HHS, and HPMS memos regarding quality ratings.

• Establish quality assurance policies and procedures for member and provider communications.

• Create QPS policies, procedures, and quality checks for ongoing departmental programs and activities.

• Design, maintain, and facilitate training for Quality Improvement Health Plan staff.

• Perform additional duties as assigned.

⛳️ Requirements

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

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

• Experience in member engagement, enhancing member experience, and familiarity with CAHPS and HOS is strongly preferred.

• At least 2 years of quality experience is preferred.

• Registered Nurse (RN), Licensed Practical Nurse, Licensed Vocational Nurse, or Licensed Clinical Social Worker (LCSW) is preferred.

• Certification as a CPHQ is preferred.

• Availability for a schedule aligned with Eastern Standard Time (EST).

• Must comply with all policies and standards.

🏝️ Benefits

• Competitive salary.

• Health insurance coverage.

• 401K and stock purchase plans.

• Tuition reimbursement opportunities.

• Paid time off in addition to holidays.

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

• Additional incentive options may be included in overall compensation.

• An equal opportunity employer dedicated to diversity.