Quality Improvement Program Consultant

A well-established managed care organization in Massachusetts is looking for a Quality Improvement Program Consultant. The qualified professional chosen for this position will participate in a team that consults with the Health and Wellness Division on regulatory, delegation, accreditation and quality improvement opportunities.

Managed Care Organization

The Quality Improvement Program Consultant  is responsible for:

• Evaluating compliance and functioning as a resource regarding the elements and the standards for NCQA, URAC, Medicare and or State Divisions of Insurance.
• Applying the concepts Continuous Quality Improvement and using CQI tools to facilitate improvement
• Collecting, analyzing and validating data used in quality initiatives within Health and Wellness
• Developing collaborative working relationships with other divisions within the organization such as pharmacy, medical leadership, and provider contracting to further accreditation readiness and clinical improvement
• Working with Program leader to identify and implement workflows and processing improvements to maximize quality, efficiency and affordability within Health and Wellness
• Coordinating committees work and facilitating effective meetings
• Developing materials for clinical and operational departments as well as delegated entities as appropriate on key operational metrics and quality improvement measures such as HEDIS
• Keeping program leader informed on key issues, risks, timetables, project milestones and areas of focus

• 3+ years of experience in Quality Improvement
• 3+ years of clinical experience or in a managed care industry
• Bachelor's degree in related field
• Familiarity with regulatory and accreditation standards, such as NCQA & URAC
• Knowledge of Continuous Quality Improvement methodologies and tools
• Experience with auditing, measurement and data analysis
• Demonstrated ability to facilitate teams, work cross-functionally and build consensus
• Proven excellent interpersonal, verbal and written communications skills

$

• RN or clinical professional with active Massachusetts license