Dec 10, 2019
Meridian
Overview
Who we are: Meridian, a WellCare Company, is part of a national network of passionate leaders, achievers, and innovators dedicated to making a difference in the lives of our members, our providers and in the healthcare industry. We provide government-based health plans (Medicare, Medicaid, and the Health Insurance Marketplace) in Michigan, Illinois, Indiana, and Ohio. As a part of the WellCare Family of companies, we deliver healthcare excellence to millions of members nationwide. Our associates work hard, play hard, and give back. Meridian associates enjoy an exceptional experience and culture including special events, company sports teams, potlucks, Bagel Fridays, and volunteer opportunities. Day in the Life of a Supv, Quality Improvement: This position works closely with the Manager of Quality Improvement to coordinate the development, implementation, documentation and evaluation of quality management initiatives within the State. Functions in a lead role within the quality team as an experienced resource for others. Assists and supports all quality management functions including QI projects, state compliance activities, disease management programs and initiatives, HEDIS, CAHPS and National Committee for Quality Assurance (NCQA), URAC or general accreditation efforts.
Responsibilities
Act as project lead and provides assignment oversight to state-specific tasks. Assists with task prioritization of the quality team in collaboration with State leadership. Participates in and maintains compliance with State quality initiatives. Serves as a representative at state quality and stakeholder meetings and within the organization in place of or with the Manager and/or Director. Coordinates design and execution of activities necessary to identify trends and important aspects of care for the Medicaid enrolled population. Identifies opportunities for improvement in Healthcare Effectiveness Data and Information Set (HEDIS) and CAHPS scores based on results of data analysis and required state performance standards. Serves as project manager or facilitator with regional teams and other departmental personnel to develop, implement and evaluate performance improvement initiatives. Assists with training new staff, identifying training and efficiency priorities, and supports training in other states and in the corporate environment. Coordinates provider outreach working with Network Development to ensure appropriate contact with provider offices through the year. Produces and reviews operations reports related to QI activities and goal performance, as assigned. Monitors and conducts quality improvement activities and performance improvement plans related to state and accreditation activities. Coordinates Member Advisory Committee and/or Member Focus Group meetings to solicit member satisfaction feedback. Documents the results of quality improvement activities in a standardized NCQA, URAC or general accreditation approved format, and develop other reporting formats as needed to meet the requirements of the State, NCQA, URAC or other regulatory bodies. Consistently demonstrates compliance with HIPAA regulations, professional conduct, and ethical practice. Leads team meetings and provides oversight to staff on quality team, including weekly meetings with each staff member. Facilitates professional development of staff to align with department and organizational objectives. Shadow manager and be able to serve as an alternate when manager not available. Monitor staff production and report to leadership on a regular basis. Lead state pay for performance project. Ability to travel, primarily within the state of employment. Perform other duties as assigned.
Qualifications
What you can bring to Meridian: A Bachelor's Degree in a related field is required 3+ years of experience in in managed care, quality management, patient education, health promotion or provider education is required Intermediate proficiency with Microsoft Outlook, Microsoft Powerpoint and Microsoft Word Advanced proficiency with Microrosft Excel and Microsoft Access Intermediate knowledge of PC environment is preferred What Meridian can offer you: Our healthcare benefits include a variety of plans that are effective on the first day of employment for our new full-time team members. Opportunity to work with the industry’s leading technologies and participate in unique projects, demonstrations, conferences, and exclusive learning opportunities. Meridian offers 401k matching that is above the national average. Full-time Meridian employees are eligible for tuition reimbursement towards Bachelor’s or Master’s degrees. Meridian was named Detroit's #1 Fastest Growing Company by Crain's Magazine, so it is a great time to get involved with Meridian. Equal Opportunity Employer
Professional Diversity Network
Detroit, MI, USA
Full-Time