Company :Highmark Inc.
Job Description :
Duties Note: The following is not intended to be an exhaustive list of all duties required of this position.
E1. Thoroughly reviews data, trends, and best practices to identify projects and approaches toward achieving excellence in area(s) of focus, including a 4 to 5 Star Rating in the CMS STAR Rating System, a 4 to 5 star rating in the QRS Rating System, and compliance with NCQA Accreditation standards.
E2. Leads focused workgroups to identify areas of improvement, develop and implement QI strategies, and ensure compliance with regulatory/accreditation bodies. Tracks progress and coordinates recommendations from workgroup members. Reports progress and workgroup recommendations to Quality Rating Oversight Committee (QROC) and progress on initiatives to the Quality Management Committee.
E3. Interfaces and coordinates efforts with various departments/vendors/contracted partners to develop and implement strategies that will address overall quality improvement, ensure compliance with regulatory requirements (NCQA, HEDIS, CMS, DOH, QRS), and align with corporate priorities.
E4. May serve as primary contact for HealthNow, New York Inc. and/or BlueCross BlueShield of WNY with the NYS DOH and other regulatory bodies as it relates to reporting requirements and quality improvement, e.g. Quality Assurance Reporting Requirements (QARR).
E5. Participates in BlueCross and BlueShield Association Quality workgroups.
N6. Coordination and oversight of readiness surrounding NCQA accreditation including conducting mock surveys to ensure compliance with accreditation standards, and coordination of evidence needed in preparation for audit requirements for all accreditation products and markets.
E7. Coordination of annual review of corporate administrative policies and procedures related to quality, accreditation and regulatory compliance.
E8. Manages projects and initiatives within the area of Health Care Quality Improvement & Reporting as needed.
N9. Performs other duties as required
Bachelors Degree: Business Admin., Healthcare Administration or related area. Masters Degree preferred. In place of a Bachelors Degree, an Associated Degree and 10 years of experience will suffice.
Minimum of 5 years healthcare related work experience with minimum 3 years experience managing projects. If Project Coordinator focus is Accreditation & Regulation, specific experience in those areas is preferred.
1. Knowledge of care management, managed care, health insurance industry, and the provider community. For Accreditation & Regulatory focus, thorough knowledge of DOH and CMS regulations and the reporting requirement components.
2. Excellent verbal and written communication skills
3. Ability to work effectively and manage multiple projects with minimal supervision
4. High degree of business maturity and demonstrated confidentiality
5. Strong organizational and leadership skills with the ability to manage multiple conflicting priorities
6. Polished, professional image and reputation
7. Demonstrated personal accountability
8. Excels in a team environment
9. Project management or process improvement experience
10. MS Word, Excel, PowerPoint
11. Strong presentation skills
12. Knowledge of Medicare processes/systems is a plus
1. Identifying issues and problems- Recognizing major issues; identifying key facts; trends, and issues; separating relevant from irrelevant data. 2. Seeking information - Identifying/recognizing information gaps or the need for additional information; obtaining information by clearly describing what needs to be known and the means to obtain it; questioning clearly and specifically to verify facts and obtain the necessary information. 3. Seeing relationships - Organizing information and data to identify/explain trends, problems, and their causes; comparing, contrasting and combining information; seeing associations between seemingly independent problems or events to recognize trends, problems and possible cause-effect relationships. 4. Proactively identify, evaluate, and solve problems with a rigorous logic and a systematic approach, and look beyond the obvious to see root cause issues and develop creative solutions.
Does this Position have Supervisory Responsibility? No
Number of Emps Supervised:
Titles of Employees Supervised:
Other Job Specifications:
External Contacts: Providers, Members
Working Conditions/Physical Demands:
* Must be able to work in an office environment
* Manual Dexterity Req: Eye-hand coordination and manual dexterity sufficient to effectively use a computer with all its components for prolonged periods of time and for the majority of required tasks
* Manual Dexterity Req: Eye-hand coordination and manual dexterity sufficient to effectively utilize various office equipment (phone, computer, fax machine, printer, copier, filing cabinet, etc)
* Heat, light, air, space and working environment typically found in an office environment
* Mental effort: Adequate to perform essential functions of the job with the type of judgements and responsibilities as indicated in the job description.
Pay Range Minimum:$57,700.00
Pay Range Maximum:$106,700.00
Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, age, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, age, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.
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