Quality Program Specialist at Southwestern Health Resources CIN in Farmers Branch, Texas

Job Description:

Quality Program Specialist

Southwestern Health Resources, a national leader in population health, is looking for a qualified Quality Program Specialist to join our Quality team.

If you're looking for a rewarding career at a patient-centered organization with work-life balance and comprehensive benefits, we want to hear from you.

Position Highlights

• Work location: This position is a Remote / Work from Home Opportunity
  
  
  
  • Travel required to office at SWHR Corporate Headquarters, 1603 LBJ Freeway, Farmers Branch, Texas 75234 as requested
    
    
  
  
• Work environment: Quality
  
  
• Work hours: Full-time, 40 hours weekly, Monday through Friday, 8 a.m.-5 p.m.
  
  
• Travel 5% Local to local payor meetings if required
  
  
• Salary range: $23.67 - $37.73 per hour (based on relevant experience)
  
  

Please note: The Quality Program Specialist is employed by SWHR. SWHR is a clinically integrated network formed by Texas Health and UT Southwestern.

Southwestern Health Resources (SWHR) is a patient-centered clinically integrated network of 29 hospital locations and more than 5,500 physicians and other clinicians. Formed by Texas Health and UT Southwestern, two of the region's leading healthcare systems, SWHR delivers nationally preeminent, highest-quality care in 16 counties across North Texas. SWHR is also the parent organization of Care N' Care Insurance Co., a regional Medicare Advantage Plan serving more than 13,500 members in the region.

The SWHR network includes physicians from UT Southwestern and Texas Health, and independent community primary care and specialty physicians. In partnership, our team implements physician-driven, value-based care strategies to coordinate care for more than 700,000 patients, resulting in lower costs and high-quality care. In 2020, the Centers for Medicare & Medicaid Services released the annual financial and quality results and, based on the report, SWHR is one of the nation's leading Next Generation Accountable Care Organizations, having saved nearly $120 million since joining the program in 2017.

Qualifications

• Bachelor's Degree Required
  
  
• 2 years' Experience with Medicare Advantage (MA), CMS Star, Clinical Quality, Healthcare Quality Improvement, or Healthcare Analytics experience; or any combination of experience which would provide an equivalent background Required
  
  
• 2 years Project/Program Coordinator Experience Required
  
  
• 2 years' Experience and knowledge of Medicare Star Preferred
  
  

Position Responsibilities SWHR Quality Program Specialist will be responsible for

Project Management
Accountable for project management of SWHRs ACO and quality stars program. Responsibility includes providing support for internal and external services lines for quality improvement activities around quality measures data such as but not limited to HEDIS, HOS, CAHPS, Pharmacy, administrative measures and regulatory/contractual requirements. Monitors and reviews progress of quality goals and initiatives reporting any barriers, delays, or red flags to manager Act as a liaison with the assigned technical analyst completing the report, the requesting department and/or stakeholder, and manage business reporting requirements and objectives to ensure that it meets the stakeholder's needs Build excellent relationships with service area leaders to work cross-functionally to collaborate on measure improvement. Organizes and documents meeting minutes and action items during Star-related meetings. Lead projects and initiatives designed to impact Stars rates, which will include coordinating activities with matrixed partners. Suggests the development and revision of operational policies and procedures, workflows, and communications (both internal and external) in support of SWHRs Stars Program

Data Management
Responsible for organizing and tracking health plan and ACO contractual data necessary for quality initiatives and monitors performance compared to market and national benchmarks. Develop reports to track and monitor quality metrics on regular cadence, reporting concerns or discrepancies to manger
Generate reports and analyses to support internal stakeholder needs including quality management, network management, sales, and other key functions. Analyses may incorporate multiple data sources, including, but not limited to: clinical gaps-in-care, member surveys, network and provider performance, operational data, etc.

Education Liaison
Serve as a Star subject matter expert and liaison between functional areas to support data requests and analyses and ensure uniform and consistent information and information flow. Maintain subject matter expertise on regulatory requirements to support MA CMS Stars program, MIPS and direct contracting
Coordinate the development and branding of marketing materials. Work independently to address questions regarding quality reports from internal and external parties. Subject matter expert to understanding quality technical specifications related to HEDIS/ ECDS and or other regulatory/ accreditation needs. Other duties as assigned.

In addition to the required qualifications, a successful Quality Program Specialist will:

• Work requires ability to effectively coordinate multiple initiatives
  
  
• Ability to work independently with minimal supervision.
  
  
• Ability to manage deadlines and handle multiple tasks simultaneously.
  
  
• Ability to exercise discretion and maintain accountability while working with member-identifiable health information.
  
  
• Work requires excellent oral and written communication skills
  
  
• Work requires excellent organizational skills.
  
  
• Work requires strong analytical/problem solving skills.
  
  
• Work requires ability to prioritize and organize work to meet deadlines, as well as time management.
  
  
• Work requires demonstrated ability and skills with project management and quality
  
  
• improvement tools, such as Microsoft Project, Visio, Excel, SharePoint.
  
  
• Knowledge of NCQA, HEDIS, Medicaid and Medicare is preferred
  
  
• Knowledge of STAR ratings is preferred
  
  
• Ability to work independently with a detailed focus on Medicare Advantage technical specifications, program design, compliance regulations and other CMS sources to effectively manage Medicare Stars ratings.
  
  

Why Southwestern Health Resources
As a Southwestern Health Resources you'll enjoy: comprehensive benefits, including a 401(k) with match; paid time off; competitive health insurance choices; healthcare and dependent care spending account options; wellness programs to keep you and your family healthy; tuition reimbursement; a student loan repayment program; and more.

Moving healthcare forward
At the heart of SWHR are people who help people. We care about those we serve and each other. To be the national leader in providing population-based healthcare, our more than 850 employees use their knowledge, data insights and clinical experience to deliver care to the right patient, at the right time and in the right setting. By connecting physicians to patients and clinical insights to better outcomes, SWHR lowers costs, optimizes value, and builds a better healthcare system for all.

We invite you to learn more about us at www.southwesternhealth.org.

Let's move healthcare forward - together.

Highlights:

• Combining the strengths of UT Southwestern Medical Center, Texas Health Resources and more than 2,500 community physicians, we offer the largest provider network in North Texas. SWHR covers approximately 700,000 patient members across 16 counties in North Texas.
  
  
• SWHR is the parent organization of Care N' Care Insurance Co., a leading regional Medicare Advantage health plan organization that serves approximately 17,000 patients in North Texas.
  
  

Additional perks of being a SWHR Quality Program Specialist

• Gain a sense of accomplishment by contributing in a teamwork environment
  
  
• Positively impact patients' quality of life
  
  
• Receive excellent mentorship, comprehensive training and dedicated clinical leadership resources
  
  
• Enjoy opportunities for growth
  
  

Explore Southwestern Health Resources Careers for more information and to search all career opportunities.

Our Recruitment team invites you to contact us with any questions at recruitment@texashealth.org.

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