Member Experience Quality Improvement Specialist (III)

Job Title

Member Experience Quality Improvement Specialist (III)

Duration

Open until filled

Work Hybrid

Yes

Description

Let’s do great things, together!

About ModaFounded in Oregon in 1955, Moda is proud to be a company of real people committed to quality. Today, like then, we’re focused on building a better future for healthcare. That starts by offering outstanding coverage to our members, compassionate support to our community and comprehensive benefits to our employees. It keeps going by connecting with neighbors to create healthy spaces and places, together. Moda values diversity and inclusion in our workplace. We aim to demonstrate our commitment to diversity through all our business practices and invite applications from candidates that share our commitment to this diversity. Our diverse experiences and perspectives help us become a stronger organization. Let’s be better together.

Position SummaryWork involves collaborating across departments to plan and implement Member Experience-related quality improvement programs, projects and interventions for Medicare, Marketplace, and Commercial products. 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.This role is responsible for leading Moda’s Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys on an annual basis and the implementation of cross-functional strategies and plans that ensure alignment with Moda’s quality roadmap.This is a full-time hybrid position based in Portland, Oregon. ​​​​Pay Range$61,877.79 - $ 77,364.89 annually*Actual pay is based on qualifications. Applicants who do not exceed the minimum qualifications will only be eligible for the low end of the pay range.

Please fill out an application on our company page, linked below, to be considered for this position.

https://j.brt.mv/jb.do?reqGK=27738323&refresh=trueBenefits:

• Medical, Dental, Vision, Pharmacy, Life, & Disability

• 401K- Matching

• FSA

• Employee Assistance Program

• PTO and Company Paid Holidays

Required Skills, Experience & Education:

• Bachelor’s degree required; master’s degree (in Statistics, Health Economics, or Public Health) preferred.

• 2 years’ experience in public health or healthcare (community-based organization, government agency, physician office, hospital, or health plan), with emphasis on quality monitoring, quality improvement or program evaluation. Master’s degree may substitute.

• Familiar with HEDIS, CAHPS, NCQA, CMS.

• Experience with quality metric standards for HEDIS, Marketplace and Medicare Stars.

• Experience in project plan coordination and development.

• Strong analytical, problem solving, decision making, organizational, and detail orientation skills.

• Proven project management skills, ability to track, and coordinate multiple projects with extended timelines.

• Ability to develop, review, and evaluate data reports.

• Strong verbal, written and interpersonal communication skills.

• Strong literature search and literature review skills.

• Demonstrated ability to translate complex findings into clear, user-friendly, and action-oriented messages.

• Self-starter with ability to propose and implement creative solutions.

• Ability to maintain confidentiality and project a professional business image.

• Proficiency in Microsoft Office, especially MS Excel and other reporting software.

Primary Functions:

• Facilitate project development of quality improvement initiatives to improve quality metrics from CAHPS survey findings.

• Lead collaborative research efforts with other departments to understand root causes of poor member experience outcomes and development of various member, community, and provider-focused quality improvement initiative solutions.

• Through healthcare research, evaluations, and quantitative analysis, summarize and synthesize complex data & information to identify trends & patterns, pinpoint issues, and areas for improvement, and recommend strategy and solutions.

• Plan and assign quality activities and tasks with a variety of outside entities and a diverse work force, including leadership, operational staff, regulatory, business analysts, technical teams, marketing, and finance.

• Report progress on projects to internal and external quality committees for feedback, collaboration, and approval. Develops annual project work plans, resource allocations, and budget impact analyses. Maintain careful expense reports and stay within an approved budget.

• Operate as the established subject matter expert in assigned products and programs related to improving the member experience.

• Continuously research and organize evidence-based best practices toward designated subject matter area using Quality Improvement team resources where possible.

• Participate in community collaborations and meet with external stakeholders.

• Consults with any teams or business areas around enhancing the member experience.

• Manage vendor partnership which leads the facilitation of Moda’s CAHPS surveys across all relevant lines of business.

• Works collaboratively with the CAHPS vendor to ensure timely and effective survey procedures. Supports the presentation of survey data to all relevant business areas as well as coordinating annual business reviews.

• Coordinates and leads executive stakeholder groups to engage business leaders in the CAHPS process, spreading awareness of the importance of member experience, and developing quality improvement projects through a collaborative process.

• Acts as a liaison between CAHPS vendor and other departments when needed.

• Acts as point of contact in communications between CAHPS vendor and Moda business areas.

• Support preparation for audits and reviews by external organizations, including the National Committee for Quality Assurance (NCQA), the Centers for Medicaid and Medicare Services (CMS), and the Oregon Health Authority (OHA).

• Writes reports and documents NCQA compliant quality improvement plans to meet accreditation standards for all product lines.

• Develop, implement, and evaluate multiple independent project-deliverables required to support Population Health and Quality Improvement as it relates to CMS, QRS, and NCQA QI requirements.

• Maintain good working knowledge of CAHPS, HEDIS, CMS, QRS and NCQA rules and regulations and ensure that the Quality Improvement operations remain compliant.

• Acts as a leader on the Quality Improvement Team. This effort can include but is not limited to the following:

• Develop and update quality improvement policies and procedures.

• Participates in mentorship of newer QI Specialist and or interns.

• Seek out and participate in professional growth and development activities.

• Perform all other duties as assigned.

Working Conditions & Contact with Others

• Office environment with extensive close PC and keyboard work, constant sitting, and occasional local travel. Work in excess of 40 hours per week, including evenings and occasional weekends, to meet business needs.

• ​​​​​​Internally with all departments. Externally community organizations, vendors, state agencies, physicians and office staff, healthcare associations and pharmaceutical representatives.

Together, we can be more. We can be better. ​​​​​​Moda Health seeks to allow equal employment opportunities for all qualified persons without regard to race, religion, color, age, sex, sexual orientation, national origin, marital status, disability, veteran status or any other status protected by law. This is applicable to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absences, compensation, and training. For more information regarding accommodations please direct your questions to Kristy Nehler and Daniel McGinnis via our humanresources@modahealth.com email.