Senior Clinical Improvement Coordinator

Job Info

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Join PacificSource and help our members access quality, affordable care!

PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, national origin, sex, sexual orientation, gender identity or age.

Diversity and Inclusion: PacificSource values the diversity of the people we hire and serve. We are committed to creating a diverse environment and fostering a workplace in which individual differences are appreciated, respected and responded to in ways that fully develop and utilize each person's talents and strengths.

Position Overview:

This position works with the Quality Improvement Coordinators to align quality projects and programs across lines of business. Responsible for program development, management, implementation and oversight of QI regulatory programs. This position works closely with clinical and business leaders in the development, implementation and gap analysis of quality improvement plans to ensure alignment and consistency with clinical, operational, strategic and performance improvement strategies. While maintaining regulatory compliance, this work will deliver on the quadruple aim of improving member and provider experience, clinical/quality outcomes and reducing the cost of health care. Leadership responsibilities include steering decisions regarding new project initiatives, implementation and mitigation planning, compliance and implementation and oversight of corrective action plans, as well as guiding internal and external department staff to achieve quality improvement initiatives and goals. This will work in partnership with the health services team and in collaboration with community and provider partners to plan and implement value aligned quality improvement programs, projects and interventions.

Essential Responsibilities:

  • Acts as a lead to provide project, program and/or initiative-related direction, guidance, training and daily oversight for Quality Improvement Coordinators.
  • Oversee quality improvement projects and work plans by assisting team with the identification of new clinical improvement opportunities through data analysis and interpretation, create alignment between projects and work plans where applicable, and ensure compliance with federal, state and program regulations.
  • Synthesize results to effectively and comprehensively assess program effectiveness, present findings to executive management and use results to drive strategy for future program enhancements.
  • Provide leadership to quality activities and discussions to drive clinical and operational program enhancements.
  • Accountable for timely and accurate completion of regulatory quality activities programs and oversight of enterprise major strategic initiatives. Formulate strategies, monitor progress, and report out program risks, results and present recommendations to senior and executive level management.
  • Manage internal and external regulatory compliance audits by preparing, editing and reviewing response documentation. Ensure understanding of and adherence to new/modified state and federal requirements. Be present and an active participant in response sessions.
  • Develop, implement and monitor corrective action plans in response to internal and external audits. Ensure timely submission and execution of corrective actions resulting in compliance with State and Federal regulations and contract requirements.
  • Maintain policies and procedures related to Clinical Quality including development of new documents. Ensure annual review, clinical decision making requirements and timelines are met.
  • Support Leader Standard Work through setting goals and metrics, visual management, idea boards and huddles.
  • Represent clinical quality team in company and community quality programs and projects.
  • Assist with vendor management, as needed, to identify ways to optimize value and performance.
  • Represent the clinical quality team and health plan in the communities and regions we serve to build collaborative partnerships.

Supporting Responsibilities:
  • Meet department and company performance and attendance expectations.
  • Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
  • Participate in and support project teams led by other departments and provide necessary input to support the goals of colleagues.
  • Perform other duties as assigned.

Work Experience: Five years of experience in healthcare or public health with varied clinical focus is required. Experience focused on program development, project management, quality improvement and application of state or federal regulation. Experience implementing and managing any of the following is strongly preferred: disease management, chronic condition management, case management, health promotion, program development. Experience in technical writing required.

Education, Certificates, Licenses: Bachelors in Public Health, Communications or other related field required. Masters degree preferred.

Knowledge: Knowledge and understanding of disease prevention, care modalities, procedure codes, including ICD-10, CPT Codes and health insurance. Knowledge of NCQA standards and Medicaid and Medicare regulations. Knowledge of quality improvement methodology. Ability to develop, review, and evaluate utilization reports. Strong analytical, problem solving, technical writing and oral presentation skills. Experience giving Executive level presentations. Strong organizational skills and attention to detail. Solid experience in using computers and various software applications including Word, Excel, PowerPoint, Outlook, SharePoint, and audio-visual equipment. Ability to work independently with minimal supervision.

  • Adaptability
  • Building Customer Loyalty
  • Building Strategic Work Relationships
  • Building Trust
  • Continuous Improvement
  • Contributing to Team Success
  • Planning and Organizing
  • Work Standards

Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 20% of the time with some overnight travel.

Our Values
  • We are committed to doing the right thing.
  • We are one team working toward a common goal.
  • We are each responsible for customer service.
  • We practice open communication at all levels of the company to foster individual, team and company growth.
  • We actively participate in efforts to improve our many communities-internally and externally.
  • We actively work to advance social justice, equity, diversity and inclusion in our workplace, the healthcare system and community.
  • We encourage creativity, innovation, and the pursuit of excellence.

Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.

Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.

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