Quality Improvement Director - Healthcare jobs in Pomona, CA

The Quality Improvement Liaison will apply his/her experience, skills and techniques to project activities to improve on the overall quality metrics within the organization. The position includes compliance and quality improvement projects (HEDIS/Medicare STARs, Medicare Risk Adjustment and Encounter data) related to all Preferred IPA product lines. The dynamic incumbent will interface with various internal and external entities or other health care stakeholders (health plans and other providers) to complete Quality Improvement projects as assigned (e.g., Health Plan Audits and various provider compliant requirements to enhance/re-enforce the core Quality Improvement metrics).

· High School Diploma required. Preferred candidates with an Associate Degree or higher.

· Minimum 3 year working experience in Health Care Quality/Quality Improvement in the health care or manage care industry.

· Experience with HEDIS/Medicare STARs, Risk Adjustment and Encounter data collection strategies.

· Experience using Microsoft Office tools including Outlook, Word, Excel, PowerPoint and Adobe Acrobat Professional.

· Experience with collecting medical records with the provider offices to impact HEDIS/Medicare STARs, Risk Adjustment and Ad Hoc requests to comply with Health Plan audits.

· Identify and collect medical records from providers for various Compliance/Quality Improvement projects.

· Collaborate with risk adjustment team to enhance RAF score/rates.

· Maintain good working relationship with provider offices/physicians.

· Develop and support strategic projects with upper management.

· Maintain a high level understanding of the business of the IPA/Medical Group.

· As needed, act as the project's point of contact for client questions on strategy and requirements, documentation, functionality and deliverables.

· Tabulation of Medical Records received: Organize and use standardized naming convention for medical records received from provider offices. Complete scanning of medical records if received by postal mail.

· Have a solid understanding of the project scope and any tasks/items impacting deadlines.

· Assist management with scheduling appointments with provider office staff to conduct chart reviews/audits/abstractions and trainings.

· As needed, work with Quality Improvement Supervisor to schedule and track the work of other team members.

· Adhere to company policies and procedures.

· Local travel up to 25% dependent upon business and client needs.

· Have valid driver license.

· Other projects as assigned.

· Demonstrate good verbal and written communication skills.

· Establish and maintain client relationships in a professional manner.

· Be comfortable interacting with internal and external entities.

· Act as an individual contributor, team lead, or team member for all assigned projects.

· Maintain an understanding of the direction and strategic initiatives in the healthcare insurance industry and how they may impact our mission.

No certification or professional licenses required for this job.

Job Type: Full-time

Pay: $52,000.00 - $58,000.00 per year

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift
• Monday to Friday

Ability to Relocate:

• Glendale, CA 91202: Relocate before starting work (Required)

Work Location: Hybrid remote in Glendale, CA 91202