Posted in Other 7 days ago.
Location: Somerville, Massachusetts
The Quality Management Specialist is responsible for two main functions: ensuring organizational readiness of all accreditation requirements including but not limited to NCQA Accreditation and management of strategic quality/clinical initiatives.
The Quality Management Specialist provides leadership and guidance to all AllWays Health Partners organizational teams and/or departments relative to accreditation processes and requirements specific to those departments and/or teams. In addition to accreditation-related responsibilities, the Quality Management Specialist is also responsible for supporting the Manager, Quality Management Strategy in a variety of quality and clinically-focused strategic initiatives including but not limited to: delegation oversight, , quality improvement activities and workgroups, , internal audits of key clinical/quality business functions, and participation in new business/product implementations.
NCQA Accreditation Essential Functions:
• Partners with the Manager, Quality Strategy to ensure organizational readiness for accreditation surveys by maintaining on-going status work-plans, ensuring completion of on-going activities, facilitating internal audits, and communicating changes to NCQA requirements to the appropriate business owners.
• Participates in conducting organizational accreditation readiness assessments by conducting audits, reviewing documented policies and procedures, and assessing all NCQA materials received by business owners (reports, policies, meeting minutes etc.)
• Collaborates with applicable business owners, to develop department specific work-plans and any needed action plans to address gaps in meeting accreditation requirements.
• Provides guidance to staff across all departments who oversee vendors and or/delegates that support NCQA functions.
• Supports policy owners to review and update policies in accordance with all accreditation and regulatory guidelines.
Clinical/Quality Strategic Initiatives Essential Functions:
• Collaborate with the Manager of Quality of Strategy to identify opportunities to improve performance of key clinical/quality functions.
• Coordinate the efforts and resources across the company to address these gaps and implement improvement plans.
• Collaborates with the Quality Assurance team to implement internal audit processes, including documentation related to utilization management, member appeals, member grievances and care management.
• Collaborates with department leaders as well as Product team to identify new opportunities and offerings. This includes identifying and vetting new vendors and services outside of the company as well as leveraging internal offerings that can support the needs of our membership.
• Develops and conducts informational trainings and develops supplemental materials as appropriate for accreditation, compliance and quality related topics.
• Support the goals of the Population Health Strategy through facilitation of various workgroups aimed at developing new workflows and/or maximizing data systems and resources.
• Other duties as assigned with or without accommodation.
WORKING CONDITIONS AND PHYSICAL EFFORT
• Ability to work remotely. Remote work in certain U.S states will be considered.
KNOWLEDGE AND EDUCATION
A Bachelor's Degree in business, public health, public administration or a related field is required.
• Masters in Healthcare Administration or MBA
• Minimum of three (3) years working at a Health Plan, ideally within Clinical or Quality Departments
• Minimum of three (2) years of NCQA or other accreditation experience in a managed care organization.
• Minimum of two (2) years of Project Management experience working with cross-functional teams
• Experience managing an NCQA Health Plan accreditation renewal survey.
• Demonstrates strong oral and written communication with a focused attention to detail.
• Understands and utilizes project management tools and skills.
• Ability to lead through collaboration and team building.
• Proficient computer skills, including MS Office Suite and SharePoint or other document management systems.
• Leads the preparation of all organizational accreditation survey submissions.
• Partners with applicable business owners, to develop department specific work-plans and any needed corrective action plans to address any gaps in meeting accreditation requirements.
• Works in conjunction with applicable business owners, to develop corrective action plans, when needed, based on the results of audits and gap analyses performed.
• Escalates potential clinical/quality compliance issues that are identified during NCQA accreditation readiness activities, policy oversight, new vendor implementations and other activities, as required, to the Manager, Quality Management Strategy.
• Independently leads assigned clinical/quality strategic initiatives and ensures the successful and timely completion of activities.
• This position interacts with all levels of staff and management including executive leadership within AllWays Health Partners.
• This position interacts with representatives from external entities including but not limited to: NCQA, CMS, Vendors providing services for AllWays Health Partners that support accreditation, MassHealth, the Massachusetts Health Care Exchange, and the Massachusetts Division of Insurance.
Our promise as a people-first organization starts with our employees. AllWays Health Partners is committed to diversity, equity, and inclusion in our workforce, internal culture, and investments. As an equal opportunity employer, AllWays Health Partners recognizes the power of a diverse community and encourages applications from individuals with varied experiences, perspectives, and backgrounds.
The above statements are intended to describe the general nature and complexity of the work being performed by personnel assigned to this classification, and do not represent an exhaustive list of all tasks, duties, and responsibilities required of personnel assigned to this position.
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