EDUCATION
Bachelor's degree in Nursing, Business, or other health-related field preferred. In lieu of degree, five (5) years' experience in quality improvement, managed care, Medicare functional areas required.
LICENSING/CERTIFICATION
Valid Driver's license with the ability to travel, as necessary, within the designated
service area required.
Healthcare license (RN, LPN, PharmD, LMSW etc.) desirable but not required
EXPERIENCE
Minimum four (4) years' in a health plan, managed care setting or direct provider quality leadership.
Minimum three (3) years' quality performance improvement including HEDIS/Stars.
Minimum two (2) years' direct HEDIS involvement including hybrid medical record collection/review and abstraction.
Experience with healthcare claims data required.
Medicare experience required.
Experience with quality improvement programs/campaigns related to HEDIS or Stars measures.
Has a solid working knowledge with NCQA (HEDIS) technical specifications.
Demonstrated experience managing/ influencing stakeholders through collaborative partnerships preferred.
Experience preparing for and facilitating quality meetings through review of analytics, development of strategic plans, and partnering with key entities preferred.
Strong knowledge of Medicare population and interworking's preferred.
Demonstrated history of successful project management desired.
Bilingual a plus.
ESSENTIAL SKILLS & ABILITIES
Strong written and oral communication skills interacting with individuals internally and externally.
Strong independent, critical thinking skills to understand individual and operational problems and identifying appropriate solution(s).
Ability to function independently and travel across the state of Arkansas to meet with various providers/provider groups to discuss ABCBS programs focused on improving the quality of care for Medicare Advantage members.
Knowledge of and ability to work within a complex health care system including advocating for member needs while balancing provider needs.
Ability to work well on their own as well as with a team and know how to conduct and interpret quantitative and qualitative analyses.
This position is identified as level three (3). This position must ensure the security and confidentiality of records and information to prevent substantial harm, embarrassment, inconvenience, or unfairness to any individual on whom information is maintained. The integrity of information must be maintained as outlined in the company Administrative Manual.
Segregation of DutiesSegregation of duties will be used to ensure that errors or irregularities are prevented or detected on a timely basis by employees in the normal course of business. This position must adhere to the segregation of duties guidelines in the Administrative Manual.
Employment TypeRegularADA Requirements
1.1 General Office Worker, Sedentary, Campus Travel - Someone who normally works in an office setting or remotely and routinely travels for work within walking distance of location of primary work assignment.
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Project Management Skill
Quality Assurance Process Skill
STARS Academy, Batesville, AR
STARS Academy, Batesville, AR