Auto req ID 1982BR Company HealthNow NY, Inc. About Us HealthNow New York Inc. is one of New York’s leading health care companies that provide access to quality health care and innovative solutions for individuals and employers. HealthNow offers a full range of insured, self-insured, and government programs and services, as well as life and disability coverage, dental and vision plans and stop-loss coverage. Headquartered in Buffalo, NY, the company operates BlueCross BlueShield of Western New York (Buffalo), BlueShield of Northeastern New York (Albany), Health Now Brokerage Concepts (Blue Bell, PA) and Health Now Administrative Services (across the Northeast US and California). In 2013 the company had revenues of $2.46B and reserves of $592 million. Title Quality Improvement Project Coordinator Status Full Time Regular Hours 8:30 - 4:30 Job Description The Quality Improvement Department is committed to assessing current systems and processes to ensure the continuous improvement and regulatory compliance of overall health service delivery. This position is responsible for identifying, implementing, and overseeing projects relating to quality improvement/compliance initiatives in one or more of the following primary areas:
•CMS Five-Star Rating System and the Quality Rating System (QRS)
•Marketplace Exchange Quality Rating Systems (QRS)
•NCQA Accreditation and state regulatory compliance •HEDIS Primary Responsibility Thoroughly reviews data, trends, and best practices to identify projects and approaches toward achieving excellence in area(s) of focus, including
a 4 to 5 Star Rating in the CMS STAR Rating System, a 4 to 5 star rating in the QRS Rating System, and compliance with NCQA Accreditation standards. Leads focused workgroups to identify areas of improvement, develop and implement QI strategies, and ensure compliance with regulatory/accreditation bodies. Tracks progress and coordinates recommendations from workgroup members. Reports progress and workgroup recommendations to Quality Rating Oversight Committee (QROC) and progress on initiatives to the Quality Management Committee. Interfaces and coordinates efforts with various departments/vendors/contracted partners to develop and implement strategies that will address overall quality improvement, ensure compliance with regulatory requirements (NCQA, HEDIS, CMS, DOH, QRS), and align with corporate priorities. May serve as primary contact for HealthNow, New York Inc. and/or BlueCross BlueShield of WNY with the NYS DOH and other regulatory bodies as it relates to reporting requirements and quality improvement, e.g. Quality Assurance Reporting Requirements (QARR). Participates in BlueCross and BlueShield Association Quality workgroups. For Accreditation & Regulatory focus, conducts mock surveys to further ensure compliance with accreditation standards, and will coordinate evidence needed in preparation for accreditation surveys. Manages projects and initiatives within the area of Health Care Quality Improvement & Reporting as needed. Performs other related duties as required. Knowledge and Skills Knowledge of care management, managed care, health insurance industry, and the provider community. For Accreditation & Regulatory focus, thorough knowledge of DOH and CMS regulations and the reporting requirement components.
Excellent verbal and written communication skills Ability to work effectively and manage multiple projects with minimal supervision High degree of business maturity and demonstrated confidentiality Strong organizational and leadership skills with the ability to manage multiple conflicting priorities Polished, professional image and reputation Demonstrated personal accountability Excels in a team environment Project management or process improvement experience MS Word, Excel, PowerPoint Strong presentation skills
Knowledge of Medicare processes/systems is a plus Qualifications Problem Solving Skills: 1. Identifying issues and problems- Recognizing major issues; identifying key facts; trends, and issues; separating relevant from irrelevant data. 2. Seeking information - Identifying/recognizing information gaps or the need for additional information; obtaining information by clearly describing what needs to be known and the means to obtain it; questioning clearly and specifically to verify facts and obtain the necessary information. 3. Seeing relationships - Organizing information and data to identify/explain trends, problems, and their causes; comparing, contrasting and combining information; seeing associations between seemingly independent problems or events to recognize trends, problems and possible cause-effect relationships. 4. Proactively identify, evaluate, and solve problems with a rigorous logic and a systematic approach, and look beyond the obvious to see root cause issues and develop creative solutions.
Budgetary Responsibilities: None
External Contacts: Providers, Members Experience or related area. Masters Degree preferred. Minimum of 5 years healthcare related work experience with minimum 3 years experience managing projects. If Project Coordinator focus is Accreditation & Regulation, specific experience in those areas is preferred. Education Required Education:Bachelors Degree (Business Admin.,Healthcare Administration) Working Conditions Must be able to work in an office environment Must be able to accommodate local travel. Valid drivers license and acceptable driving history required due to travel involved with this position (DMV check will be conducted to review candidate's driving record) Manual Dexterity Req: Eye-hand coordination and manual dexterity sufficient to effectively use a computer with all its components for prolonged periods of time and for the majority of required tasks Manual Dexterity Req: Eye-hand coordination and manual dexterity sufficient to effectively utilize various office equipment (phone, computer, fax machine, printer, copier, filing cabinet, etc) Heat, light, air, space and working environment typically found in an office environment Mental effort: Adequate to perform essential functions of the job with the type of judgements and responsibilities as indicated in the job description. Removal Date 04-Oct-2019