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Manager, Quality Member Experience

  • Posted: over a month ago
  • $31,280 to $72,988 Yearly
  • Full-Time
  • Benefits: dental, life_insurance, medical, vision, 401k
Job Description: POSITION SUMMARY: Provides guidance, and training to the Quality department and organization-wide staff that impact member experience improvement initiatives. This position will ensure the effective management of member experience survey ratings, including member and provider outreach. ESSENTIAL DUTIES AND RESPONSIBILITIES: · Develops, plans, and implements initiatives and other quality member experience improvement strategies, making recommendations for change as needed. · Directs the member experience processes to ensure the health plan is NCQA-accredited and is a 4+ STAR rating. · Ensures pre-CAHPS member surveys are fielded on a monthly basis and communicates results with external provider groups · Build and maintain relationships with other departments internally, as well as external provider groups, as it relates to STARS and NCQA. · Implements survey improvement initiatives including CAHPS committee meetings to ensure company-wide involvement to increase member survey scores. · Creates wellness materials for marketing distribution to aid in member retention and health improvement efforts. · Maintains an expert technical understanding of HEDIS, CAHPS, HOS, NCQA and Meaningful Use measures set by CMS performance standards. · Manages and monitors performance for CAHPS/HOS survey vendor · Develops and implements Medicare AWV/HRA program to increase provider and member participation · Sets actionable and achievable goals for Quality Department implementation toward earning and maintaining a 4 STAR · Creates training material on member experience surveys for organization-wide staff. · Must maintain confidentiality of business information, including Protected Health Information (PHI), as required by HIPAA and company policy. · Performs other duties as assigned EDUCATION AND EXPERIENCE: · Bachelor’s degree or equivalent experience required · 5-years experience in a clinical or health insurance setting required · 5-years experience managing data to create reports required · Experience in medical quality, marketing, risk adjustment, coding, and/or wellness preferred · Requires a valid state Driver’s License KNOWLEDGE, SKILLS AND ABILITIES: · Ability to communicate and manage complex working relationships · Ability to train internal and external parties · Strong organizational, verbal, written, time management, and telephone skills · Computer literate and familiar with Microsoft applications (Word, Excel, Outlook) · Basic electronic health record knowledge and ability to quickly learn new software · Detailed knowledge of quality performance measures and clinical health care · Ability to collaborate across departments WORK ENVIRONMENT: This job operates in a clerical, office setting. This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines. This is a largely sedentary role; however, some filing is required, which would require the ability to lift files, open filing cabinets and bend or stand on a stool as necessary. May need to lift to 25lbs. TRAVEL: Required travel to present Quality survey updates to in-network provider groups as well as educational conferences for updates on measures or best practices SUPERVISORY RESPONSIBILITY: This position has no direct supervisory responsibilities but does serve as a coach and mentor for other positions in the organization that contribute to member experience ratings. OTHER DUTIES: This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.


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