Primary Job Duties & Responsibilities 

• Develops and implements quality improvement programs and initiatives to monitor and improve healthcare services and processes. Quantitatively and qualitatively analyzes organizational systems and performance in alignment with regulatory and accreditation standards.  

• Drives and implements evidence-based performance improvement interventions that address areas for improvement, reduce variations in care, and enhance clinical effectiveness. Establishes, tracks and monitors process and outcome measures. Prepares materials and organizational documents and effectiveness for POSC Forum, POSC Council and POSC workgroup discussions in alignment with relevant project plans.   

• Manages and coordinates specific workplans for assigned POSC workgroups. Facilitates relevant workgroups and committees as required to ensure stakeholder awareness and participation.  

• Contributes to enhancing healthcare services, improving patient outcomes, and ensuring adherence to regulatory requirements and industry standards.  

• Contributes to the development, revision, and implementation of policies, procedures, and guidelines that focus on system performance, network provider and community partner performance, and addressing barriers including health disparity and health related social needs, to improve clinical quality, promote best member and provider experience, and ensure patient safety. 

• Stays up to date on healthcare innovations, quality studies and evidence-based practices by participating in research efforts, contributing to scholarly publications, and/or facilitating research utilization to improve clinical care and outcomes. 

• Provides training and education to healthcare professionals, staff, and stakeholders on HEDIS and CAHPS related performance, workflow, and dependencies.  

• Collaborates with all POSC stakeholders and participants to ensure cross-functional collaboration, education and participation in establishing, measuring and evaluating best practice interventions aimed to achieve Quality performance goals.   

Essential Qualifications and Functions:  The minimum knowledge, skills, and abilities (KSAs) which are absolutely required to successfully perform  

• 5-7 years prior relevant work experience – in clinical, case management, administrative, quality / compliance or HEDIS performance-based roles 

• In depth knowledge of managed care quality, HEDIS and STARs measures, as well as  initiatives aimed to drive performance 

• Strong interpersonal, critical thinking, and analytic skills 

• Working knowledge of quantitative / qualitative data analytics, and critical thinking skills. 

• Working knowledge of clinical and practice requirements essential to meet patient care needs. 

• Ability to deal tactfully with customers and community. 

• Ability to manage sensitive information ethically and responsibly.  

• Ability to consider the relative costs and benefits of potential actions to choose the most appropriate option. 

• Ability to function in clinical setting with diverse cultural dynamics of clinical staff and patients. 

• Excellent communication/presentation and technical writing skills 

• Registered Nurse (RN) required. Adept at problem solving and decision-making skills 

• Adept at collaboration and teamwork  

• Adept at growth mindset (agility and developing yourself and others) skills 

• Adept at execution and delivery (planning, delivering, and supporting) skills

• Master’s degree in healthcare related field 

• Certified Professional in Healthcare Quality (CPHQ) preferred. 

BSN required

Master's degree in healthcare related field preferred