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Program Coordinator- Quality Medicare Advantage

Location

This position is located in Kearny Mesa, San Diego County



Hours

8-hour shift: 7:30 am – 4:30pm, some evenings and weekends as needed.



Required Skills and Qualifications

Bachelor’s Degree in health care field or health care administration, business or related field
10+ years’ experience in position requiring high levels of cooperation, collaboration, analysis, troubleshooting, and problem resolution in the healthcare industry.
10+ years’ managing complex CMS programs including health care systems and software.
Experience in the successful design, implementation and completion of interdepartmental project management. Knowledge and experience in health plans or physician organizations with Medicare Advantage populations including familiarity with quality improvement, utilization management, and disease management.
Knowledge of CMS, NCQA, HEDIS, P4P, Medicare Stars and other performance metrics.
Experience with population health management and health information management; knowledgeable about compliance and reporting initiatives; proven ability to manage performance improvement projects.
Excellent verbal and written communication skills; strong interpersonal skills. Strong ability to read and interpret documents addressing performance incentive programs, program specifications, etc.
Ability to manage multiple projects and priorities. Skill in working across departmental lines


Preferred Skills and Qualifications

Master’s degree in health care administration, business or related field
Knowledge of managed care, Health Plan contracts, and benefits. Understanding of ICD- and CPT coding.
Certification in Project Management

Summary

In collaboration with the SHP Medical Directors and QI Manager, this position will provide oversight for Sharp Health Plan’s improvement strategies related to population health and performance metrics for the Medicare Advantage product. The position coordinates the implementation and maintenance of strategic programs designed to improve clinical outcomes through the provision of clinical information and education materials to both providers of care and to members. The position acts as a key lead in the team responsible for the measurable improvements in ambulatory clinical quality and population health management that provide value to the health plan resulting in a strong business case for improved clinical outcomes and meeting CMS requirements.





A day in the life of a Program Coordinator- Quality Medicare Advatange at Sharp Health Plan will include:



Design, implement and lead analytical processes and reporting metrics for the Medicare Stars process improvement program.
Collaborate with others across the Sharp system and Plan delegates including the PBM to support QI strategies for MA Stars programs.
Implementation of special initiatives to support the analytical and reporting needs of the QI department and its delegates for CMS programs working closely with the Pharmacy Benefits department to collaborate on quality improvement initiatives.
Provides coordination with Plan medical groups to gather required contractual data in conjunction with the Compliance department for CMS audits.
Supports both long and short-term projects, which require organization, research, analysis, planning, development, modeling, validating and/or coordination such as written QI studies required by CMS.
Serves as point person for reporting, research, analysis and coordination for QI department for CMS –required programs.


This might be the job for you if you are:

A self-starter who has a knack for implementing order and processes
Someone who thrives in fast-paced environments with multiple deadlines and deliverables
An excellent communicator (verbal and written)
Someone who can turn ambiguity into action
Good at creative problem solving and decision-making
Someone who possesses an eye for detail
A team player who can effectively manage up and across an organization
Good at working with cross-functional teams




Here's what Sharp Health Plan has to offer you:

Sharp Health Plan is the largest, locally-based commercial health plan in San Diego. We are a not-for-profit organization serving the needs of San Diegans since 1992. As a subsidiary of Sharp HealthCare, San Diego’s largest provider of health care services, we not only serve the people of San Diego, we are the people of San Diego.



Through our unique integration with Sharp HealthCare, we connect our members to an award-winning network of hospitals, medical groups and physicians. We offer health insurance options for individuals, families, groups and businesses that combine affordability, choice, high-quality health care and personal service.



Sharp Health Plan is the highest member-rated Health Plan among reporting California Health Plans.* We're also accredited by the National Committee for Quality Assurance (NCQA) with a status of Commendable which is awarded to organizations with well-established programs for service and clinical quality. We continually strive to improve the quality of our services and benefits, and seek innovative solutions to today’s complex health care issues. From helping you find the right health plan to the right doctor to being a great place to work, we’re here for you!



If you like the sound of what it means to be a Sharp Health Plan team member, and you meet the qualifications above, please submit your resume along with a brief explanation about why you would be a good fit for this position. We look forward to hearing from you.



*The source for this data is Quality Compass® 2016 and is used with the permission of the National Committee for Quality Assurance (NCQA). Quality Compass® 2016 includes certain CAHPS® data.



Sharp HealthCare is proud to be an Equal opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, gender identity, transgender status, sexual orientation, protected veteran status or any other protected class

Time:  Full time
Salary:  Hourly
Category:  Clinical/pharmacy/quality

Updated: 8/6/2018 3:11:39 PM