QI Business Analyst, Sr

Identifies and recommends quality improvement opportunities through reporting, process and trend analysis to support Quality initiatives. Guides key quality improvement initiatives through shared services and the markets to improve WellCare’s Quality position.

Essential Functions:
  • Responsible for monitoring and reporting on the status of departmental projects: Anticipates and identifies issues that could inhibit achieving the project goals and objectives, and implementing corrective actions and mitigation strategies.
  • Administers and supports market oversight meetings and ensure appropriate follow up is completed.
  • Responsible for training new associates.
  • Analyzes key metrics, such as top diagnoses, clinical procedures, and operational performance, to enable the development of sound and valid recommendations regarding and prioritization of clinical and service improvement initiatives.
  • Analyzes, updates, and modifies procedures and processes to continually improve QI operations.
  • Collects and summarizes performance data and identifies opportunities for improvement.
  • Serves as knowledge expert for assigned quality improvement activities.
  • Develops market oversight meeting decks, compiling information from all necessary reports.
  • Monitors and analyzes outcomes to ensure goals, objectives, and desired outcomes are achieved.
  • Administers and supports member/provider communications and strategy.
  • Pursues methods to ensure receipt of data required for trending and reporting of various QI work plan metrics, performs adequate data/barrier analysis, develops improvement recommendations, and deploys actions as approved.
  • Manages activities that cross multiple markets and departments for improvement in quality outcomes.
  • Assists in activities to prioritize clinical and service improvement initiatives.
  • Participates in various QI committees and work groups convened to improve process and/or health outcomes, and contributes meaningful detail, based on functional knowledge. Completes follow-up as assigned.
  • Conducts business analysis and recommends solutions to management as to course of action that best meets the organization's goals
  • Monitors and tracks market progress on market specific activities and conducts the appropriate follow up needed to ensure status updates are complete and accurate.
  • Performs other duties as assigned.
Additional Responsibilities:
    Candidate Education:
    • Preferred A Bachelor's Degree in Healthcare, Nursing, Health Administration, Public Health or related field or equivalent work experience
    Candidate Experience:
    • Required 3 years of experience in Quality Improvement or Business Analysis
    • Required 5 years of experience in a healthcare delivery organization such as a MCO or a hospital environment
    Candidate Skills:
    • Advanced Demonstrated written communication skills
    • Advanced Demonstrated interpersonal/verbal communication skills
    • Advanced Ability to multi-task
    • Advanced Ability to work in a fast paced environment with changing priorities
    • Advanced Ability to effectively present information and respond to questions from families, members, and providers
    • Advanced Ability to identify basic problems and procedural irregularities, collect data, establish facts, and draw valid conclusions
    • Intermediate Knowledge of healthcare delivery
    • Advanced Demonstrated time management and priority setting skills
    • Advanced Ability to implement process improvements
    Licenses and Certifications:
    A license in one of the following is required:
    • Preferred Licensed Registered Nurse (RN)
    • Preferred Licensed Practical Nurse (LPN)
    Technical Skills:
    • Required Intermediate Microsoft Excel
    • Required Intermediate Healthcare Management Systems (Generic)
    • Required Intermediate Microsoft Word
    • Required Intermediate Microsoft Outlook

      About us
      Headquartered in Tampa, Fla., WellCare Health Plans, Inc. (NYSE: WCG) focuses primarily on providing government-sponsored managed care services to families, children, seniors and individuals with complex medical needs primarily through Medicaid, Medicare Advantage and Medicare Prescription Drug Plans, as well as individuals in the Health Insurance Marketplace. WellCare serves approximately 5.5 million members nationwide as of September 30, 2018. WellCare is a Fortune 500 company that employs nearly 12,000 associates across the country and was ranked a "World's Most Admired Company" in 2018 by Fortune magazine. For more information about WellCare, please visit the company's website at www.wellcare.com. EOE: All qualified applicants shall receive consideration for employment without regard to race, color, religion, creed, age, sex, pregnancy, veteran status, marital status, sexual orientation, gender identity or expression, national origin, ancestry, disability, genetic information, childbirth or related medical condition or other legally protected basis protected by applicable federal or state law except where a bona fide occupational qualification applies. Comprehensive Health Management, Inc. is an equal opportunity employer, M/F/D/V/SO.