Quality Performance Specialist

Quality Performance Specialist

Your career starts now. We're looking for the next generation of healthcare leaders.

At AmeriHealth Caritas, we're passionate about helping people get care, stay well, and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services, and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we'd like to hear from you.

Headquartered in Newtown Square, PA, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services.

Role Overview : The Quality Performance Specialist is responsible for the coordination and ongoing monitoring of Quality Improvement (QI) program objectives, including the delivery of performance improvement projects for service and clinical activities, integrating the quality improvement plan into all departments, and facilitating Healthcare Effectiveness Data & Information Set (HEDIS), Consumer Assessment of Healthcare Providers & Systems (CAHPS) and National Committee for Quality Assurance (NCQA) accreditation activities. Implements and supports the overall implementation of quality programs that meet or exceed applicable State, Federal, and NCQA standards.

Work Arrangement : RemoteThe Associate must be willing to travel to New Hampshire two to three days a week to meet with providers.

Responsibilities :

• Executes on organizational efforts in ongoing quality improvement processes to ensure compliance with State, Federal, regulatory, and accrediting bodies' standard requirements
• Responsible for the completion and analysis of annual HEDIS results and works with all areas to integrate results into departmental goals
• Experience with PDSA (Plan-Do-Study Act) Cycle expertise preferred.
• Understanding of rapid-cycle improvements
• Responsible for the successful development and evaluation of an annual QI work plan and program description by facilitating QI throughout the organization
• Identifies, resolves, and / or escalates problematic QI areas that may place the plan at risk of not achieving annual goals
• Collaborates with Provider Services and Member Services to complete analysis of annual satisfaction surveys and works with all areas to integrate results into departmental goals
• Participates in the development, implementation, and maintenance of QI policies and procedures
• Serves as a resource to other departments in completing QI goals
• Works professionally and efficiently with all functional areas in meeting organizational and departmental quality goals
• Participates in QI committees structured to achieve outcomes success and completes committee documentation that is consistent with regulatory and accrediting body requirements

Education & Experience :

Skills & Abilities :

Licensure :

Our Comprehensive Benefits Package :

Flexible work solutions include remote options, hybrid work schedules, competitive pay, paid time off, including holidays and volunteer events, health insurance coverage for you and your dependents on Day 1, 401(k), tuition reimbursement, and more.