Business Consultant RN, Quality Management
Job ID 2012-21362 # Positions 1
Location US-VA
Search Category Nursing
Type Regular Full-Time (30+ hours) Posted Date 12/3/2012
Additional Locations ..
More information about this job:
Summary:
The Quality Management (QM) Business Consultant is responsible for improving Amerigroup’s value to our customers by supporting continuous quality improvement in healthcare services delivered to its members, as well as for improving Amerigroups performance on all clinical outcome related measures. This responsibility extends to the Medicaid and Medicare lines of business.
Responsibilities:
1. Will serve as a facilitator/champion for two or more clinical quality management department sponsored workgroups and committees. This will include one or more quality domain workgroups and Plan/Corporate HEDIS workgroups. The incumbent’s role is to facilitate and organize business process development/improvement from launch through implementation as well as ongoing evaluation and revision.
2. Will be responsible to develop and implement clinical quality initiatives that will ensure Amerigroup meets or exceeds accreditation and regulatory requirements as determined by NCQA, CMS, state DOH and DOI entities as well as compliance with health care reform.
3. Will be responsible for the retrieval and analysis of various types of data sets as well as searching current literature in an effort to identify potential barriers to members receiving necessary preventive services. Data sets will include but not be limited to HEDIS, state specific HEDIS-like information, CMS Stars information and measures related to Amerigroups Long Term Care product, those required for healthcare reform and those related to Amerigroup clinical quality initiatives, such as patient safety.
4. Responsible for keeping abreast of internal and external activities not directed by CCQM that impact HEDIS strategy and outcomes and to appropriately collaborate and factor this information into the development of clinical quality initiatives.
5. Will require the ability to synthesize analysis and information from data and provide clinical expertise and recommendations for member and provider interventions towards improvement.
6. Upon direction from the AVP Performance Outcomes, will serve on corporate and plan teams focused on outcomes management; for example, the corporate health promotions workgroup, ad hoc teams to support outcomes information for RFP’s and RFI’s, etc.
7. Will be responsible for defining and creating best practices among health plans and through research, communicating information enterprise wide and creating standardized tools, templates and training materials.
8. Works closely with corporate and health plan HEDIS, accreditation and clinical guideline staff.
9. Other duties as assigned.
Qualifications:
EDUCATION AND EXPERIENCE
Education
Required:
- Associate’s degree in Nursing.
Preferred:
- Bachelor’s degree in Nursing, business or health care management.
Years and Type of Experience Required:
Required:
- 3 years experience as a Registered Nurse.
- 3-5 years experience in healthcare/health plan operations using quality improvement tools, process analysis.
Preferred:
- 1-2 years experience in managed care quality management environment.
Specific Technical Skills
Required:
- 3 years experience in managing projects and use of MS Office products.
Preferred:
- 1-2yrs experience with HEDIS and/or clinical outcome measures.
Certifications or Licensures
Required:
- RN Licensure.
Other:
Required:
- Excellent verbal and written communication skills.
- Ability to evaluate quality data to make comparisons, develop goals, recommendations and action plans based on results.
- Ability to facilitate and lead cross functional/multi-departmental teams related to clinical quality improvement.
Preferred:
- Effective planning and implementation skills.
PHYSICAL REQUIREMENTS
The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Must be able to operate general office equipment including but not limited to: computer, phones and related media and information devices.
- Ability to communicate both in person and/or by telephone.
- Must be able to travel as needed and adhere to Amerigroup travel policies and procedures.
Job ID 2012-21362 # Positions 1
Location US-VA
Search Category Nursing
Type Regular Full-Time (30+ hours) Posted Date 12/3/2012
Additional Locations ..
More information about this job:
Summary:
The Quality Management (QM) Business Consultant is responsible for improving Amerigroup’s value to our customers by supporting continuous quality improvement in healthcare services delivered to its members, as well as for improving Amerigroups performance on all clinical outcome related measures. This responsibility extends to the Medicaid and Medicare lines of business.
Responsibilities:
1. Will serve as a facilitator/champion for two or more clinical quality management department sponsored workgroups and committees. This will include one or more quality domain workgroups and Plan/Corporate HEDIS workgroups. The incumbent’s role is to facilitate and organize business process development/improvement from launch through implementation as well as ongoing evaluation and revision.
2. Will be responsible to develop and implement clinical quality initiatives that will ensure Amerigroup meets or exceeds accreditation and regulatory requirements as determined by NCQA, CMS, state DOH and DOI entities as well as compliance with health care reform.
3. Will be responsible for the retrieval and analysis of various types of data sets as well as searching current literature in an effort to identify potential barriers to members receiving necessary preventive services. Data sets will include but not be limited to HEDIS, state specific HEDIS-like information, CMS Stars information and measures related to Amerigroups Long Term Care product, those required for healthcare reform and those related to Amerigroup clinical quality initiatives, such as patient safety.
4. Responsible for keeping abreast of internal and external activities not directed by CCQM that impact HEDIS strategy and outcomes and to appropriately collaborate and factor this information into the development of clinical quality initiatives.
5. Will require the ability to synthesize analysis and information from data and provide clinical expertise and recommendations for member and provider interventions towards improvement.
6. Upon direction from the AVP Performance Outcomes, will serve on corporate and plan teams focused on outcomes management; for example, the corporate health promotions workgroup, ad hoc teams to support outcomes information for RFP’s and RFI’s, etc.
7. Will be responsible for defining and creating best practices among health plans and through research, communicating information enterprise wide and creating standardized tools, templates and training materials.
8. Works closely with corporate and health plan HEDIS, accreditation and clinical guideline staff.
9. Other duties as assigned.
Qualifications:
EDUCATION AND EXPERIENCE
Education
Required:
- Associate’s degree in Nursing.
Preferred:
- Bachelor’s degree in Nursing, business or health care management.
Years and Type of Experience Required:
Required:
- 3 years experience as a Registered Nurse.
- 3-5 years experience in healthcare/health plan operations using quality improvement tools, process analysis.
Preferred:
- 1-2 years experience in managed care quality management environment.
Specific Technical Skills
Required:
- 3 years experience in managing projects and use of MS Office products.
Preferred:
- 1-2yrs experience with HEDIS and/or clinical outcome measures.
Certifications or Licensures
Required:
- RN Licensure.
Other:
Required:
- Excellent verbal and written communication skills.
- Ability to evaluate quality data to make comparisons, develop goals, recommendations and action plans based on results.
- Ability to facilitate and lead cross functional/multi-departmental teams related to clinical quality improvement.
Preferred:
- Effective planning and implementation skills.
PHYSICAL REQUIREMENTS
The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Must be able to operate general office equipment including but not limited to: computer, phones and related media and information devices.
- Ability to communicate both in person and/or by telephone.
- Must be able to travel as needed and adhere to Amerigroup travel policies and procedures.