It’s Time For A Change…
Your Future Evolves Here
Evolent Health has a bold mission to change the health of the nation by changing the way health care is delivered. Our pursuit of this mission is the driving force that brings us to work each day. We believe in embracing new ideas, challenging ourselves and failing forward. We respect and celebrate individual talents and team wins. We have fun while working hard and Evolenteers often make a difference in everything from scrubs to jeans.
Are we growing? Absolutely—56.7% in year-over-year revenue growth in 2016. Are we recognized? Definitely. We have been named one of “Becker’s 150 Great Places to Work in Healthcare” in 2016 and 2017, and one of the “50 Great Places to Work” in 2017 by Washingtonian, and our CEO was number one on Glassdoor’s 2015 Highest-Rated CEOs for Small and Medium Companies. If you’re looking for a place where your work can be personally and professionally rewarding, don’t just join a company with a mission. Join a mission with a company behind it.
Who You’ll Be Working With:
This position is accountable for overseeing all aspects of the Passport Health Plan’s Medicaid and Medicare Quality programs objectives, including but not limited to guiding the delivery of performance improvement projects for service and clinical goals, integrating the quality improvement plan into all departments and facilitating Healthcare Effectiveness Data Information Set (HEDIS), The Consumer Assessment of Healthcare Providers and Systems (CAHPS®) and National Committee of Quality Assurance (NCQA) accreditation activities.
What You’ll Be Doing:
- Oversees and directs the quality improvement projects, including, but not limited to:
- HEDIS data collection & reporting project
- Health Plan Surveys, including CAHPS and provider satisfaction surveys and subsequent analysis
- Compliance audit preparation, including DMS and EQRO audits
- Conducts medical record reviews as needed to support regulatory requirements, including HEDIS, CPG, and Medicaid quality indicator reporting
- Performs review and analysis of data from survey tools, including but not limited to, provider satisfaction survey and CAHPS surveys
- Supports data collection, analysis and submission required for health plan quality improvement monitoring and
- Supports QI Workgroup activities and special projects as
- Provides direction on Quality Improvement (QI) documents, including but not limited to: QI Program Description, QI Program Evaluation, QI Work Plan, policies and procedures and QI Project
- Conducts review of established quality programs to determine efficiency, adherence to policy and effectiveness.
- Acts as a liaison/facilitator with other departments to improve health plan processes and implement quality improvement processes by collaborating with all departments in the quality improvement process in pursuit of compliance with State, Federal, the organization and accrediting body
- Provides direction and evaluates annual QI workplan and program description by facilitating QI throughout the organization and serving as a resource to other departments in completing goals. Identify, resolve and/or escalate problematic areas that may place plan at risk of not achieving above
- Facilitates NCQA mock and accreditation reviews, annual HEDIS reporting, and the annual CAHPS survey. Accountable for successful results in all audits, including the coordination and resolution of compliance issues in other
- Develops and implements QI design of clinical and service projects including but not limited to DMS required
- Oversees delegated entities as pertaining to quality improvement policies and standards.
- Guides QI activities that meet or exceed applicable DMS, CMS and NCQA regulatory and contractual requirements for the Medicaid line of
- Manages and directs assigned Quality Improvement
- Demonstrates leadership ability and communication skills in directing, motivating, and developing staff to ensure acceptable quality of work.
- Monitors and reviews work performance and output to evaluate staff, provides feedback, develops staff, and implements new procedures that ensure efficient utilization of limited resources.
- Delegates in a manner that fosters employee growth and development.
- Works efficiently with all functional areas in meeting organizational and departmental
- Perform other duties and projects as
The Experience You’ll Need (Required):
- Bachelor’s degree in health care related field or equivalent
- 7-10 years of experience in quality improvement managed healthcare
- 7-10 year of management experience
- 5-7 years of experience in managed Medicaid
- Successful management of accreditation survey required, NCQA
- 2-5 years managed Medicare experience
- Valid RN License
Finishing Touches (Preferred):
- Lives and leads the values: Integrity, Community, Collaboration and Stewardship, as defined in the performance
- Excellent organizational, analytical and interpersonal
- Ability to develop and maintain operational
- Excellent written and verbal communication skills.
- Proficient experience using Outlook, Word, Excel and PowerPoint in a Windows operating
Evolent Health is an Equal Opportunity/Affirmative Action Employer