Verified Job
Work from home
Quality Improvement Specialist
Work from home
#668901
Remote / WFH
Job Description
Join our dedicated team and contribute to prioritizing health!
The Quality Improvement Specialist plays a vital role in enhancing healthcare outcomes by collaborating with clinicians and the Stars Clinical Quality team. This position supports clinical and operational teams, including center administrators, to implement best practices aimed at improving Medicare quality measures (HEDIS), patient safety, and the overall patient experience (CAHPS-HOS). You may be assigned to assist Conviva PCO staffed providers or Independent Network provider/practices in a similar capacity.
• The ideal candidate should have a passion for working with clinical quality measures, especially in medication adherence and HEDIS.
• Engage patients with timely medication reminders through approved methods.
• Conduct medical record reviews, retrieve necessary documents, and submit findings to health plans to close HEDIS gaps effectively.
• Provide actionable data to clinical teams and operations, facilitating targeted actions to optimize performance (requires moderate to advanced Excel skills).
• Analyze provider/member detail HEDIS data and gap reports to pinpoint improvement opportunities and strategies for closure.
• Leverage critical thinking to identify areas for improvement, streamline workflows, and address existing barriers.
• Support specific provider/practice needs to drive the successful implementation of quality improvement strategies.
• Manage workloads effectively, ensuring timely distribution of medication adherence reports to PCPs.
• Train and educate teams on CMS Star measures either individually or in group settings (including clinicians, medical assistants, practice administrators, and front office staff).
• Exceptional interpersonal skills are essential, as the role involves building relationships and collaborating within a team-driven environment.
• Present STARs performance outcomes during various meetings, creating compelling PowerPoint presentations as needed.
• Work closely with diverse stakeholders including internal teams (market operations, coding teams, medical directors) and external partners to support and execute workflows that enhance HEDIS outcomes, patient safety, and experience.
• Assist in promoting quality initiatives such as eye screenings, bone mineral density assessments, and mobile mammograms.
Utilize your expertise to create meaningful impact!
Required Qualifications:
Strong understanding of healthcare quality measures such as STARS (HEDIS, Patient Experience (CAHPS/HOS)) and familiarity with measure specifications.
At least 2 years of experience working with CMS STARs quality metrics.
Prior experience in a fast-paced healthcare environment, ideally involved in direct patient care, front office tasks, or provider relations.
Demonstrated experience in conducting training sessions, both individually and in groups.
The ability to work autonomously while adhering to team guidelines and standardized workflows.
Proficiency in Microsoft Office Suite (Word, Excel, PowerPoint) with strong communication and presentation skills.
Must be willing and able to travel locally to our CenterWell/Conviva Centers.
Preferred Qualifications:
Bachelor's or Associate's Degree.
Previous experience as an LPN/LVN, Lead Medical Assistant, or Center Administrator.
Familiarity with Humana's internal policies, procedures, and systems.
Additional Information:
Work schedule: Monday to Friday, 8 AM to 5 PM, with occasional after-hours meetings.
This position allows for remote work with travel to various medical centers and/or IPA offices.
Must reside in the Houston, Texas area.
Scheduled Weekly Hours:
40
Pay Range:
The estimated salary range for this full-time position is $59,100 - $79,900 annually, reflecting a good faith estimate and subject to location and individual skill level.
Description of Benefits:
Humana and its subsidiaries provide comprehensive benefits promoting overall wellness. Our offerings include medical, dental, vision insurance, a 401(k) retirement plan, paid time off, and various other benefits tailored to support your well-being and work-life harmony.
About Us:
CenterWell Senior Primary Care focuses on delivering proactive, preventive care tailored to seniors, including wellness visits, chronic condition management, and more. Our unique care model emphasizes personalized experiences, ensuring our integrated teams provide compassionate care that leads to improved health outcomes.
As part of Humana Inc., CenterWell is committed to prioritizing whole-person health, creating a supportive workplace culture for over 30,000 clinicians dedicated to exceptional patient care. We offer flexible scheduling, opportunities for clinical certification, leadership development, and career coaching to ensure our employees thrive both personally and professionally.
Equal Opportunity Employer:
Humana is an equal opportunity employer, committed to nondiscrimination based on race, color, religion, sex, ****** orientation, gender identity, national origin, age, marital status, disability, or veteran status.
The Quality Improvement Specialist plays a vital role in enhancing healthcare outcomes by collaborating with clinicians and the Stars Clinical Quality team. This position supports clinical and operational teams, including center administrators, to implement best practices aimed at improving Medicare quality measures (HEDIS), patient safety, and the overall patient experience (CAHPS-HOS). You may be assigned to assist Conviva PCO staffed providers or Independent Network provider/practices in a similar capacity.
• The ideal candidate should have a passion for working with clinical quality measures, especially in medication adherence and HEDIS.
• Engage patients with timely medication reminders through approved methods.
• Conduct medical record reviews, retrieve necessary documents, and submit findings to health plans to close HEDIS gaps effectively.
• Provide actionable data to clinical teams and operations, facilitating targeted actions to optimize performance (requires moderate to advanced Excel skills).
• Analyze provider/member detail HEDIS data and gap reports to pinpoint improvement opportunities and strategies for closure.
• Leverage critical thinking to identify areas for improvement, streamline workflows, and address existing barriers.
• Support specific provider/practice needs to drive the successful implementation of quality improvement strategies.
• Manage workloads effectively, ensuring timely distribution of medication adherence reports to PCPs.
• Train and educate teams on CMS Star measures either individually or in group settings (including clinicians, medical assistants, practice administrators, and front office staff).
• Exceptional interpersonal skills are essential, as the role involves building relationships and collaborating within a team-driven environment.
• Present STARs performance outcomes during various meetings, creating compelling PowerPoint presentations as needed.
• Work closely with diverse stakeholders including internal teams (market operations, coding teams, medical directors) and external partners to support and execute workflows that enhance HEDIS outcomes, patient safety, and experience.
• Assist in promoting quality initiatives such as eye screenings, bone mineral density assessments, and mobile mammograms.
Utilize your expertise to create meaningful impact!
Required Qualifications:
Strong understanding of healthcare quality measures such as STARS (HEDIS, Patient Experience (CAHPS/HOS)) and familiarity with measure specifications.
At least 2 years of experience working with CMS STARs quality metrics.
Prior experience in a fast-paced healthcare environment, ideally involved in direct patient care, front office tasks, or provider relations.
Demonstrated experience in conducting training sessions, both individually and in groups.
The ability to work autonomously while adhering to team guidelines and standardized workflows.
Proficiency in Microsoft Office Suite (Word, Excel, PowerPoint) with strong communication and presentation skills.
Must be willing and able to travel locally to our CenterWell/Conviva Centers.
Preferred Qualifications:
Bachelor's or Associate's Degree.
Previous experience as an LPN/LVN, Lead Medical Assistant, or Center Administrator.
Familiarity with Humana's internal policies, procedures, and systems.
Additional Information:
Work schedule: Monday to Friday, 8 AM to 5 PM, with occasional after-hours meetings.
This position allows for remote work with travel to various medical centers and/or IPA offices.
Must reside in the Houston, Texas area.
Scheduled Weekly Hours:
40
Pay Range:
The estimated salary range for this full-time position is $59,100 - $79,900 annually, reflecting a good faith estimate and subject to location and individual skill level.
Description of Benefits:
Humana and its subsidiaries provide comprehensive benefits promoting overall wellness. Our offerings include medical, dental, vision insurance, a 401(k) retirement plan, paid time off, and various other benefits tailored to support your well-being and work-life harmony.
About Us:
CenterWell Senior Primary Care focuses on delivering proactive, preventive care tailored to seniors, including wellness visits, chronic condition management, and more. Our unique care model emphasizes personalized experiences, ensuring our integrated teams provide compassionate care that leads to improved health outcomes.
As part of Humana Inc., CenterWell is committed to prioritizing whole-person health, creating a supportive workplace culture for over 30,000 clinicians dedicated to exceptional patient care. We offer flexible scheduling, opportunities for clinical certification, leadership development, and career coaching to ensure our employees thrive both personally and professionally.
Equal Opportunity Employer:
Humana is an equal opportunity employer, committed to nondiscrimination based on race, color, religion, sex, ****** orientation, gender identity, national origin, age, marital status, disability, or veteran status.
