Quality Coordinator

• Serves as NCQA subject matter expert, ensures health plan compliance and support as it relates to department programs and activities.
• Initiate, facilitate and coordinate quality improvement activities and metrics to support assigned NCQA standards and requirements.
• Proactively keep all staff updated on NCQA standards and application, through notifications of change, workflow and documentation updates, and training.
• Analyze, promote, and implement updates to department operations to effectively support health plan accreditation.
• Conduct quality monitoring and auditing of system documentation to include member records.
• Partner with Quality Management team to support health plan NCQA accreditation.
• Complies with timelines and deadlines.
• Create, revise, and maintain all supporting documentation, including program descriptions, reports, work instructions, workflows and policies.
• Provides quality update at Quality Improvement committees to include Case Management Committee.
• Support staff training with the assistance of department trainer.
• Performs case management delegation oversight activities of providers in collaboration with Delegation & Quality Coordinator.
• Member satisfaction survey administrator.
• Oversee administration of department member satisfaction surveys for multiple clinical programs by ensuring survey workflow consistently continues, barriers are removed, and deadlines are met.
• Facilitate print / mail workflow with administrative and IT services.
• Validate data and process flow.
• Prepare file for mail merge by administrative support team.
• Maintain master data collection file.
• Quality assurance monitoring through system documentation.
• Prepare monthly report to managers.
• Share member feedback with staff.
• Research negative comments and low scored responses.
• Partner with Corporate Analytics for data analysis.
• Support staff training with the assistance of department trainer.
• Identify opportunities for improvement, facilitate & implement interventions.
• Reporting, Data, and Analytics
• Prepares reports and presentations to educate and communicate information and results related to metrics, requirements, operation & audit trends, project and quality improvement activities.

Duties include, but are not limited to :

• Program evaluations
• Outcome summaries
• Identifies, coordinates and participates in quality monitoring and improvement opportunities to improve program performance, facilitate change, and take action to implement ideas.
• Takes initiative to research issues, conduct root cause analysis, documents
• Program Operations
• Targeted member communications : Identify target population and develop & maintain communication material for initiative and program communication via mailing and alternative communication channels.
• Create, update, and maintain : Program descriptions, Policies & procedures, workflows, work instructions, reference documents and, operational manuals.
• Oversee maintenance and accuracy of online material related to department programs.
• Delegation
• Serves as additional support and back-up to delegation point and activities such as :
• Host & facilitate meetings with provider organizations.
• Chart audit activities
• Program evaluations
• General program support such as material / correspondence reviews, billing / invoice workflow, report development & presentations.
• Performs all other miscellaneous responsibilities and duties as assigned or directed.
• Assists with special projects and department priorities / initiatives.
• Support staff & operations to ensure daily operations continue.

LI-Hybrid