Clinical Performance Improvement Coordinator

<strong>Working at Advantasure is more than a job &mdash; you&rsquo;re part of a team that is becoming the country&rsquo;s leading healthcare solutions provider.<br /></strong><br /><strong>A career at Advantasure means you&rsquo;ll be part of one of the most dynamic, diversified and innovative healthcare companies in the nation. You&rsquo;ll be helping our clients make their members healthier &mdash; and our communities a better place to call home.</strong>

Richmond, MI


<p class="p1"><strong>At Advantasure, we partner with healthcare clients to simplify their operations and accelerate their business success. Powered by our broad expertise and a comprehensive suite of product and service solutions, we help health plans effectively navigate the complexity of healthcare.</strong></p>

keywords: summary,quality assurance,support,teamwork,document,analysis,reporting,skills,experience,knowledge,management,education,certification


Competitive Compensation and Benefits Package

Overview: <p>Organize and coordinate activities to ensure full compliance with all regulatory and licensing agencies (e.g., CMS, MDCH, and NCQA) and employer groups relative to health management activities, including accreditation site surveys and regulatory reviews. Coordinate, facilitate, assess, and evaluate improvement initiatives for health management team utilizing process improvement methodology.</p>
Responsibilities: <ul> <li>Document the Chronic Care Improvement Program (CCIP) for multiple health plan contracts, for their review and approval.</li> <li>Responsible for oversight of quality improvement initiatives assigned to Health Management to include all CCIP planned initiatives.&nbsp; Provides oversight of process to improve HEDIS rates related to above.&nbsp;</li> <li>Document the Quality Improvement Program Evaluation for a single client, for their review and approval.</li> <li>Collaborate with Advantasure HEDIS and Stars teams, Appeals &amp; Grievance department, and Case Management.</li> <li>Assist in development and implementation of quality management policy and procedures, and development of quality management programs.</li> <li>Attend Advantasure Quality Oversight Committee meetings to collaborate and engage in activities to streamline current quality management processes and present new processes.</li> <li>Conduct quality improvement studies for Health Management to assist in identification of gaps.</li> <li>Responsible for all client Quality of Care (QOC) complaint investigations, obtaining medical records, and direct communication with Advantasure Medical Directors based on findings.</li> <li>Responsible for QOC reporting to clients monthly and as needed depending severity score.</li> <li>Promote and engage in positive and constructive daily teamwork.</li> <li>Provide support to the Health Management leadership team.</li> <li>Provide support in developing and maintaining NCQA accreditation and compliance with regulatory standards.&nbsp; Responsibility includes summarizing and analyzing accreditation standards and reports, preparation of reports/presentations for Advantasure committees and leadership and assisting in evaluating strategic initiatives in relationship to new and existing standards</li> </ul>
Requirements: <p><strong>EDUCATION:</strong></p> <p>Bachelor&rsquo;s degree in nursing, allied health, risk management or other health care related field preferred.&nbsp; CPHQ certification preferred.&nbsp; Risk management certification preferred.</p> <p><strong>EXPERIENCE:</strong></p> <p>Four (4) years of acute patient care with broad clinical background required.&nbsp; Three (3) years quality management/ performance improvement experience with at least one (1) year audit/reporting experience preferred.&nbsp; Will also consider utilization management, discharge planning or case management experience in place of up to two years of quality management/assurance experience.</p> <p><strong>SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED</strong></p> <ul> <li>Experience in a health plan/managed care philosophy, policies, and procedures.</li> <li>Medical management processes across the continuum of care.</li> <li>Knowledge of outcomes management, quality reporting components, project management.</li> <li>Knowledge of CQI quality management principles and program.</li> <li>Standard medical procedures and their application as well as current trends and developments in medicine and nursing.</li> <li>Knowledge of accreditation process and regulatory processes.</li> <li>Case management and disease state management processes preferred.</li> <li>Knowledgeable of HEDIS measurement and Star ratings.</li> <li>State and federal HMO regulations preferred.</li> <li>Excellent statistical, analytical, problem-solving and decision making</li> <li>Strong organizational, planning and follow through</li> <li>Well-developed time management and prioritization</li> <li>Excellent communications skills; written and oral</li> <li>Good negotiating skills; Good interpersonal/team relations</li> <li>PC literate</li> <li>Ability to work well with minimal supervision</li> </ul> <div id="gtx-trans" style="position: absolute; left: -175px; top: 26px;">&nbsp;</div>