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Job Posting Title

Senior Quality Specialist

Job Description Summary

Serves as a member of the quality team at the national, regional or unit level. Coordinates projects resulting in continuous quality improvement and process improvement. Supports the maintenance of a strong quality program, measured processes including URAC, NCQA and/or HEDIS (where applicable) and reported outcomes.

Job Description

• Lead assigned quality and process improvement activities which may include accreditation support, process improvement projects, quality studies, CQI (continuous quality improvement) process training for staff, prevention program coordination, care coordination initiatives, satisfaction survey coordination and follow-up, provider and member advisory groups (where applicable), tracking of adverse incidents, monitoring of performance guarantees, CAPs and customer related quality initiatives.

• Knowledgeable and/or SME in Accreditation (NCQA and/or URAC) requirements (where applicable).

• Provides or supports direct interventions with members and providers to address gaps in care or compliance.

• Prepares status reports on activities and outcomes of interventions and activities.

• Providing consultation and training to staff on quality, accreditation, and core performance indicators measurement specifications.

• Provide assistance as needed in data maximization efforts through coordination with the company's Central HEDIS team (where applicable).

• Lead CQI (continuous quality improvement) processes and studies related to improved outcomes.

• Provides interface with internal and external customers for accreditation and/or HEDIS (where applicable) planning, reporting and program enhancements.

• Responsible or supports Quality Improvement Activities and established ROI.

• Able to work independently.

Responsibilities

• 5+ years of quality improvement and auditing or related experience in healthcare field.

• 5+ years of HEDIS related experience (where applicable).

• Knowledge of healthcare quality improvement processes, accreditation standards, and HEDIS/performance measurement.

• Attention to detail and able to work efficiently to meet deadlines and timelines.

• High degree of organization required.

• Excellent verbal and written skills and the ability to enter data accurately into spread sheets and prepare professional looking documents and reports.

• Expertise and proficient in data management, data analysis, reporting word processing, and project management skills.

• Independently develops, understands, and communicates the extrapolated data to stakeholders.

• Proficient knowledge of Microsoft Excel, VISIO, Tableau, Cognos, and/or MS Project.

• Excellent verbal and written skills and the ability to enter data accurately into spread sheets and prepare professional looking documents and reports.

• Experience working independently & managing quality improvement activities resulting in Return on Investment (ROI).

• Ability to take lead on projects and run meetings with stakeholders.

• Experience in Lean Six Sigma.-MA in health care or related field.

• CPHQ - Certified Professional In Healthcare Quality.

Work Experience

Work Experience - Required:

Quality

Work Experience - Preferred:

Education

Education - Required:

Bachelors - Healthcare

Education - Preferred:

Masters - Healthcare

Certifications

Certifications - Required:

Certifications - Preferred:

CPHQ - Certified Professional In Healthcare Quality - Care Mgmt - Care Mgmt, LSSBB - Lean Six Sigma Black Belt Certification - Enterprise - Enterprise, LSSGB - Lean Six Sigma Green Belt Certification - Enterprise - Enterprise

Potential pay for this position ranges from $65,570.00 - $104,910.00 based on experience and skills. Pay range may vary by 8% depending on applicant location.

To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page (https://www.primetherapeutics.com/careers/benefits/) and click on the "Benefits at a glance" button for more detail.

Prime Therapeutics LLC is an Equal Opportunity Employer. We encourage diverse candidates to apply and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), sexual orientation, gender identity or expression, genetic information, marital status, family status, national origin, age, disability, veteran status, or any other legally protected class under federal, state, or local law.

Prime Therapeutics' fast-paced and dynamic work environment is ideal for proactively addressing the constant changes in today's health care industry. Our employees are involved, empowered, and rewarded for their achievements. We value new ideas and work collaboratively to provide the highest quality of care and service to our members.

If you are looking to advance your career within a growing, team-oriented, award-winning company, apply to Prime Therapeutics today and start making a difference in people's lives.

Prime Therapeutics LLC is an Equal Opportunity Employer. We encourage diverse candidates to apply and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status. ​ If you are an applicant with a disability and need a reasonable accommodation for any part of the employment process, please contact Human Resources at 1.866.469.1257 or email Careers@primetherapeutics.com.