POSITON SUMMARY/RESPONSIBILITIES
In collaboration with health plan leadership, responsible for the implementation, evaluation and management of the organization's health plan accreditation and process improvement and activities. Functions as a resource person for accreditation standards as they apply to all aspects of the organization, to include guidance on interpretation and monitoring of standards. Leads and/or coordinates process improvement activities related to patient safety, accreditation standards and quality improvement across the health plan. Assists in the development of process metrics, data collection tools/systems and presentation/analysis of resultant data.
EDUCATION/EXPERIENCE
Bachelor’s degree in health care or health-related field required. Master’s degree in a health-related field preferred. Thorough knowledge of accreditation standards (i.e., NCQA and HEDIS), health care regulations (Centers for Medicare and Medicaid Services and Texas Department of Health and Human Services) and process improvement required. Evidence of significant participation in an accreditation cycle required. Documented work experience in the management of process improvement and three years experience in application of quality improvement methodologies with application of statistical methods required. Quality certification preferred.
LICENSURE/CERTIFICATION
Current RN licensure in the State of Texas is required if applicable.
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