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Conservation Representative - Waco (AM Shift)

CalOptima

Conservation Representative - Waco (AM Shift)

Orange, CA
Paid
  • Responsibilities

     

    Participates and supports the Quality Analytics department by tracking and trending all performance metrics related to quality and improvement.  Participates in program and project monitoring and implementation to improve quality performance metrics, overall member satisfaction and member access to care which includes but is not limited to issuing corrective action plans to the health networks.  Participates in various projects that support department goals, as well as leading smaller projects as needed.

     

    POSITION RESPONSIBILITIES:

    • Generates reports and logs for tracking and data analysis to identify areas of low (or very high) performance based on comparison to established goals/benchmarks. (ex. NCQA Reports, network adequacy reports, and out-of-network reports).
    • Reviews, monitors and tracks quality performance data related, but not limited to HEDIS/CAHPS, member and provider experience, and access to care, against internal and external benchmarks TO IDENTIFY PERFORMANCE GAPS AND IDENTIFY OPPORTUNITIES FOR IMPROVEMENT in a timely manner.
    • Coordinates all phases of projects, including project planning, implementation and monitoring results of Corrective Action Plans (CAPs) for areas of low performance.
    • Updates project plans, develops and maintains process flows, maintaining project related materials (ex. action plans, intervention logs, tracking and trending CAPs) and other project related tasks as necessary.
    • Provides support to cross functional work teams and committees.
    • Acts as the lead on smaller, time-limited projects where there may be a need to perform data collection, analysis, reporting and presentation of project activities.
    • Assists in the development and maintenance of various desktops, policies and procedures affecting the operations of the department.
    • Identifies opportunities to improve efficiency of business processes.
    • Conducts research on requests for information from executives, directors, project managers, and other staff to support project initiatives.
    • Other projects and duties as assigned.

    Required Skills

     

    • Apply project management tool and methodologies.
    • Organize and track numerous and diverse projects/activities, timelines and issues.
    • Work independently and as an effective member of a team.
    • Communicate effectively both verbally and in writing with staff at various levels within CalOptima as well as external contacts.
    • Effectively utilize computer and appropriate software such as Microsoft Office applications.
    • Evaluate the effectiveness of interventions and projects.
    • Prepare and present clear and concise reports, which reflect understandable data, analysis and appropriate findings.
    • Initiate and follow-through on projects with little supervision or guidance.
    • Coordinate multiple project and administrative activities at the same time.

    Required Experience

     

    EXPERIENCE & EDUCATION:

    • Bachelor's degree in Public Health, Health Care, Health Administration or a related field or an equivalent combination of experience and experience is required; Master’s preferred.
    • 2 years of professional experience in a managed health care organization, preferably in a capitation model.
    • Experience in project management or equivalent work experience preferred.
    • Experience with HEDIS, CAHPS and/or other quality performance standards, preferred.
    • Experience with NCQA, CMS, DHCS quality performance metrics, preferred.
    • Experience with managed care and quality improvement required.

                                                                  

    KNOWLEDGE OF:

    • Continuous quality improvement methodologies preferred.
    • HEDIS, CAHPS and other quality performance standards preferred.
    • NCQA, CMS, DHCS, preferred.
    • Principles and process of effective project management.
    • Principles of continuous quality improvement (PDSA, etc.) preferred.
    • Principles of effective analysis and report writing.
    • Principles and practices of managed health care, health care systems and medical administration.

     

     

    Grade:  K

     

    #CB

  • Qualifications

     

    • Apply project management tool and methodologies.
    • Organize and track numerous and diverse projects/activities, timelines and issues.
    • Work independently and as an effective member of a team.
    • Communicate effectively both verbally and in writing with staff at various levels within CalOptima as well as external contacts.
    • Effectively utilize computer and appropriate software such as Microsoft Office applications.
    • Evaluate the effectiveness of interventions and projects.
    • Prepare and present clear and concise reports, which reflect understandable data, analysis and appropriate findings.
    • Initiate and follow-through on projects with little supervision or guidance.
    • Coordinate multiple project and administrative activities at the same time.