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PacificSource Health Plans Quality Improvement Coordinator in Eugene, Oregon

Overview

Work involves collaborating with the health services team to plan and implement Medicaid quality improvement programs, projects and interventions. While maintaining regulatory compliance, this work will deliver on the quadruple aim of improving member and provider experience, clinical/quality outcomes and reducing the cost of health care.

Responsibilities

  • Develop, implement, and author quality improvement projects and programs to ensure compliance with the Oregon Health Authority (OHA) program regulations.

  • Prepare, implement, and monitor annual Transformation and Quality Strategy.

  • Identify evidence or outcome based interventions in collaborationwith health services, providers, and community partners through performance analysis and research.

  • Align quality programs with PacificSource strategic goals and major initiatives. Coordinate work with key stakeholders including providers, community organizations, and state workgroups to ensure project requirements and deliverables are met.

  • Create detailed reports of project progress as required by contracts and state regulations. Ensure timely submission to state health authorities.

  • Report progress on projects to internal and external quality committees for feedback, collaboration, and approval.

  • Represent PacificSource and the quality department in the communities and regions we serve to build collaborative partnerships. Attend local and state meetings including the OHA Quality and Health Outcomes Committee (QHOC), regional CCO meetings, and others as appropriate.

  • Participate in relevant community partnerships.

  • Maintain good workingknowledge of Medicaid rules and regulations and ensure that the Quality Improvement operations remain compliant.

  • Prepares relevant documents and participates in External Quality Review.

Supporting Responsibilities:

  • Meet department and company performance and attendance expectations.

  • Participate in and support project teams led by other departments and provide necessary input to support the goals of colleagues

  • Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.

  • Perform other duties as assigned.

Qualifications

Work Experience:Three years experience in healthcare or public health with varied clinical focus required. Experience in program development, writing and application of state or federal regulations preferred. Experience implementing and managing any of the following is strongly preferred: disease management, chronic condition management, case management, health promotion, program development.

Education, Certificates, Licenses:Bachelors in Public Health or other related field required or a combination of equitable work and education experience.

Knowledge:Knowledge and understanding of disease prevention, program development, quality improvement methodology, and health insurance. Knowledge of Medicaid rules and regulations. Ability to develop, review, and evaluate utilization reports.Strong writing, analytical and problem solving skills.Experience giving presentations. Organizational skills with solid experience in using computers and various software applications including Word, Excel, PowerPoint, Outlook, SharePoint, and audio-visual equipment. Ability to work independently with minimal supervision.

Competencies

Our Values

  • Adaptability

  • Building Customer Loyalty

  • Building Strategic Work Relationships

  • Building Trust

  • Continuous Improvement

  • Contributing to Team Success

  • Planning and Organizing

  • Work Standards

  • We are committed to doing the right thing.

  • We are one team working toward a common goal.

  • We are each responsible for our customers’ experience.

  • We practice open communication at all levels of the company to foster individual, team and company growth.

  • We actively participate in efforts to improve our communities-internal and external.

  • We encourage creativity, innovation, continuous improvement, and the pursuit of excellence.

Environment:Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately10%of the time.

Physical Requirements:Stoop and bend.Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.

Diversity and Inclusion: PacificSource values the diversity of the people we hire and serve. We are committed to creating a diverse environment and fostering a workplace in which individual differences are appreciated, respected and responded to in ways that fully develop and utilize each person’s talents and strengths.

Disclaimer:This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.

PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, national origin, sex, sexual orientation, gender identity or age.

Job ID2019-488

TypeRegular Full-Time

of Openings1

StatusExempt

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