Founded in 1996, Texas Children's Health Plan is the nation's first health maintenance organization (HMO) created just for children. We provide STAR/Medicaid and Children's Health Insurance Program (CHIP) to pregnant women, teens, children and adults in Houston and surrounding areas. Currently, the Health Plan has more than 375,000 members who receive care from our network of more than 1,100 primary care physicians, 3,200 specialists, and 70 hospitals. Texas Children's Health Plan is also the largest combined STAR/CHIP Managed Care Organization in the Harris County service area.
To join our community of 14,000+ dedicated team members, visit texaschildrenspeople.org for career opportunities. You can also learn more about our amazing culture at infinitepassion.org .
Texas Children's is proud to be an equal opportunity employer. All applicants and employees are considered and evaluated for positions at Texas Children's without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, gender identity, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.
Summary:
Job Summary:
We're looking for a Senior Quality Improvement Specialist, someone who's ready to grow with our company. This position facilitates process improvement by leading process improvement using QI methodology, coordinating quality improvement committees and advisory committees, completing regulatory reporting requirements, leading provider site process improvement, and researching the latest developments in process improvement to ensure TCHP's QI program and work plan are leveraging innovative and high impact interventions. This role will also serve other operational duties to meet the QI needs of Texas Children's Health Plan.
Think you've got what it takes?
Responsibilities:
Lead process improvement to meet the objectives defined by the Quality Improvement Program (QI Program) for the highest priority objectives tied to financial risk or require significant interdepartmental coordination for process improvement.
Establish annual QI work plan for each assigned QI objective. This includes calculating baseline performance and establishing surrogate markers to measure progress toward aim, developing QI tools to organize and communicate the work plan, completing standard report outs to communicate QI progress to leadership.
Lead process improvement workgroups. This includes: building a cross-functional process improvement team, completing cause/effect analyses using internal and external sources, developing key driver diagrams to connect interventions with aim, leading rapid PDSA (plan, do study, act) cycles and pivoting interventions based on outcomes of PDSA.
Incorporate high impact population health interventions into process improvement. This includes reviewing relevant evidence-based literature in quality improvement, implementing population health interventions used by other health plans for improvement on nationally used quality measures (i.e., HEDIS measures and PPE measures).
Design, extract, and analyze the health plan's quality outcomes data. This includes managing data in Microsoft Excel at an advanced level, using business intelligence tools developed by TCHP to capture data in Enterprise Data Warehouse, extracting and interpreting data produced by TCHP's third party quality analytics vendors, and completing quantitative and qualitative analyses of quality related data.
Research and incorporate the latest developments in process improvement to ensure TCHP's QI program and work plan are leveraging innovative and high impact interventions.
Lead and optimize TCHP's proactive and regulatory data collection to improve performance on HEDIS and CAHPS survey measures.
Lead process improvement at provider sites to support provider's performance on high impact quality measures and adherence to clinical practice guidelines
Lead provider audit activities to advise corrective action in response to complaints or concerns regarding a provider in TCHP's provider network
Complete regulatory reporting requirements related to oversight of MCO Quality performance.
Regulatory HEDIS Support
Support ongoing quality related efforts across the Health Plan as determined by Quality Leadership.
Requirements:
Being fully vaccinated against COVID-19, including any booster dose(s) of the COVID-19 vaccine recommended by the Centers for Disease Control when eligible, is required for all employees at Texas Children's unless approved for a medical or religious exemption.
Required bachelor's degree
Preferred RN - Lic-Registered Nurses
Required 3 years Project management or process/quality improvement experience
