Population Health Quality Specialist at WPS Health Solutions in Indianapolis, Indiana
Posted in Other 30+ days ago.
Job Description:
Description
Population Health Quality Specialist
Role Summary:
The Population Health Quality Specialist conducts oversight of population health management programs aimed at improving the health and wellness of our members. This position has the responsibility of implementing a goal-driven population strategy to maximize engagement and define and monitor success metrics. Provides support to the overall maintenance of the health plans National Committee for Healthcare Quality Assurance (NCQA) accreditation, which includes project coordination of benchmarking related to clinical performance and patient experience through Health Plan Effectivess Data and Information Set (HEDIS) and Consumer Assessment of Healthcare Providers and Systems (CAHPS).
This position will coordinate, educate, and provide expertise to customers in regards to WPS Health Insurance's Population Health Programs. In addition, the role will provide recommendations and direction on population health programs with the goal of providing the best possible health outcomes for members
In this role you will:
- Take a lead role in identifying continual process improvement strategies and facilitates contractual relationships with vendors and other provider systems .
- Responsible for developing and communicating recommendations for program continuation or modification based on program outcome measures and member engagement.
- Address quality issues and support active efforts to address resolution and/or corrective action.
- Participate in organizational quality improvement efforts and perform activities related to quality initiatives and population health programs.
- Coordinate health plan's participation in CAHPS survey
- Participate in HEDIS chart abstraction, audit and data submission process and evaluate results and implement improvement strategies if needed.
- Assist with organizational compliance of standards and guidelines involving NCQA accreditation.
- Lead the annual Quality Improvement Work Plan and initiatives.
- Perform focus studies, data collection, trend analysis related to quality and health plan performance..
- Present outcomes to employer groups.
- Generate quarterly and monthly reports.
- Organize and facilitate training, education and support for staff regarding compliance and quality issues identified through audit process.
This role could be a good fit if you:
- Enjoy working for a company that does not fear change and champions new ideas.
- Have a passion for making processes more efficient.
- Possess excellent reading comprehension, written communication, calculation, presentation, and social interaction skillsets.
- Enjoy having the ability to influence the delivery of health care.
- Are able to utilize sound reasoning and analysis for creative problem-solving..
- Have expertise in Microsoft Office and similar programs.
You'll benefit from this experience by:
- Working with a management team committed to maintaining a high performing work culture.
- Working in an environment that has very strong team cohesion and comradery across all areas.
- Are a continuous innovator who stretches boundaries and continually seeks out new ways to solve tough problems in a complex business environment.
- Working in an environment that serves our Nation's military, veterans, Guard and Reserves along with their families.
You need to have:
- Bachelors degree in Business, Nursing or other health related field OR equivalent post high school education and or work experience.
- 3 or more years of clinical or health plan experience involving driving, measuring and reporting outcomes involving population health management standards.
We also prefer: (Any other possiblepreferredskills?)
- Preferred RN License or LPN License
This role is open to considering 100% remote work, we are highly interested in applicants that are regionally local to the Madison area, to be able to come into the office on occasion after Covid-19.
Approved States: Arizona, Colorado, Florida, Georgia, Illinois, Indiana, Iowa, Michigan, Minnesota, Missouri, Nebraska, New Jersey, North Carolina, North Dakota, South Carolina, Texas, Virginia, Wisconsin
Your team:
You will be working with a team of 9 medical and pharmacy clinicians and health insurance professionals.
Compensation and Benefits
- Eligible for annual Performance Bonus Program
- 401(k) with dollar-per-dollar match up to 6% of salary
- Competitive paid time off
- Health and dental insurance start DAY 1
- Vision insurance
- Flexible spending, dependent care, and health savings accounts
- Short- and long-term disability, group life insurance
- Dress for your day
- Innovative professional and cognitive development programs
Who We Are
WPS Health Solutions is an innovator in health insurance and a worldwide leader in claims administration, serving millions of beneficiaries in the United States and abroad.
Founded in 1946, WPS offers health insurance plans for individuals, families, and seniors, and group plans for small and large businesses. We are a world-class claims processor and program administrator for the government's Medicare program. And we manage benefits for millions of active-duty and retired military personnel and their families.
Our Purpose and Values
Our purpose is to make healthcare easier for those we serve. Click Here
Our values - Customer Focused, Individual Responsibility, Mutual Respect, and Driven & Passionate - are the core of who we are and how we conduct business every day.
WPS Health Insurance
WPS Health Insurance offers high-quality health insurance plans for individuals and families, Medicare supplement plans for seniors, and group health plans for businesses of every size.
http://wpshealthsolutions.com/business-units/wpshi.shtml
Military and Veterans Health
WPS Military and Veterans Health administers claims and provides customer service and related activities for the U.S. Department of Defense and the U.S. Department of Veterans Affairs and their beneficiaries.
http://wpshealthsolutions.com/business-units/wpsmvh.shtml
Government Health Administrators
WPS Government Health Administrators manages Medicare Part A and Part B benefits for more than 7 million beneficiaries. As one of the largest contractors for the Centers for Medicare & Medicare Services, we've served Medicare beneficiaries and their health care providers since 1966.
http://wpshealthsolutions.com/business-units/wpsgha.shtml
WPS Health Plan
WPS Health Plan offers Health Maintenance Organization and Point-of-Service plans to the group and individual markets in eastern and north-central Wisconsin, plus third-party administrator services.
http://wpshealthsolutions.com/business-units/wpshi.shtml
EPIC Specialty Benefits
EPIC Specialty Benefits provides businesses group insurance products that cover:
- Life
- Disability
- Dental
- Vision
- Voluntary benefits
http://wpshealthsolutions.com/business-units/epicsb.shtml
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Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information. 41 CFR 60-1.35(c)
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