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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.
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.
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.
Monitors and analyzes outcomes to ensure goals, objectives, and desired outcomes are achieved.
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.
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 as needed to ensure status updates are complete and accurate.
Develops market oversight meeting decks, compiling information from all necessary reports.
Administers and supports market oversight meetings and ensure appropriate follow up is completed.
Manages activities that cross multiple markets and departments for improvement in quality outcomes.
Administers and supports member/provider communications and strategy.
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
Required 2 years of experience in Quality Improvement or Business Analysis
Required 3 years of experience in a Healthcare delivery organization, such as managed care or hospital environment
Advanced Demonstrated written communication skills
Advanced Demonstrated interpersonal/verbal communication skills
Intermediate Ability to multi-task
Intermediate Ability to work in a fast paced environment with changing priorities
Intermediate Ability to effectively present information and respond to questions from families, members, and providers
Intermediate Ability to identify basic problems and procedural irregularities, collect data, establish facts, and draw valid conclusions
Intermediate Knowledge of healthcare delivery
Intermediate Demonstrated time management and priority setting skills Ability to remain calm under pressure
Intermediate Ability to implement process improvements Ability to work overtime as required
Licenses and Certifications: A license in one of the following is required:
Preferred Licensed Registered Nurse (RN)
Preferred Licensed Practical Nurse (LPN)
Required Intermediate Microsoft Outlook
Required Intermediate Microsoft Word
Required Intermediate Microsoft Excel
Required Intermediate Healthcare Management Systems (Generic)