Quality Rater Jobs in Iowa (NOW HIRING)

The Quality & Operations Improvement Specialist - Population Health will work with Population Health and ACO Operations leadership to manage and improve performance in value-based contracts and across population health outcomes.  This position will partner with leadership to implement the UI Healthcare Population Health and Value-Based Care Strategy, including efforts to redesign care delivery to manage chronic conditions upstream, improve preventive screening rates, improve HEDIS performance, improve transitions of care, and reduce health disparities. This position will be responsible for HEDIS and ACO quality performance management, including monitoring performance, identifying opportunities for improvement, and facilitating and leading assigned continuous quality and operational improvement initiatives to improve performance.  Provide operational support to direct multiple strategic, mission-critical projects using process improvement initiatives, data collection and analysis, standard status reporting, audit structures, and consultation services to improve performance in value-based contracts and to achieve the Quintuple Aim.

Position Responsibilities:

        Create and manage processes for value-based quality performance management (HEDIS, STARS, ACO), to include monitoring performance, identifying and communicating risks and improvement opportunities, and creating data visualizations for communication of performance to key stakeholders

        Communicate with payor partners to review quality performance, clarify measure specifications, understand performance drivers, and align on reporting expectations

        Use data to identify and prioritize quality improvement opportunities, communicate insights to leadership for strategy development

        Support value-based provider incentive program, including assessing measure type and structure, monitoring and communicating performance to leadership and stakeholders, collaborating to calculate performance and payment, and ensuring programmatic success.

        Manage Medical Director Quality Improvement Project component of provider incentive program, including consultative support to participating Medical Directors, management of all tracking, and ensuring participants present results upon completion.

        Develop audit structures for quality and operational processes as an output of process improvements.

        Collaborate with Enterprise Analytics to develop data validation structures to ensure internal performance management outputs align with payor-reported performance, including but not limited to auditing non-compliant records for validity, assessing measure specifications and supplemental data feeds regularly, analyzing outliers, and collaborating with clinical partners to validate clinical measures.

        Assist with the tracking, reporting, and championing follow-up work for all process improvements across the team.

        Plan, estimate, organize, and manage multiple assigned projects of various sizes within the department.

        Manage assigned quality improvement initiatives through project life cycle, collaborating with key partners, acting as a change agent, using project management and Lean Six Sigma tools as needed, and ensuring sustainable operational change is implemented to support strategic priorities

        Develop and maintain positive, collaborative relationships with project stakeholders and teams, including clinical, Healthy Planet, HCIS, Quality Office, payors, ACO, data and analytics, research, and others, to build buy-in, share information, and drive change across the enterprise..

        Maintain an appropriate communication plan across project teams and work groups.

        Employ change management techniques to build buy-in and maintain team enthusiasm, energy, and focus.

        Adapt work schedule to ensure project deadlines are met.

        Ensure standards of care, regulatory compliance, QA, and safety regulations are followed.

        Utilize Key Performance Indicators (KPIs) to ensure improvement activities and projects are successfully moving forward.

        Utilize systematic data-driven methods to identify and monitor if project progress is favorable or if alternative actions need to be taken.

        Assist with measuring project progress, forecasting completion dates, and analyzing project variances across multiple projects.

        Provide training to Population Health team on quality tools developed for the department. Train key stakeholders on Lean principles and techniques such as A3s, Root Cause Analysis and PDSA.