Regional Quality Lead

P3 Health Partners•Omaha, NE

14h•$30 - $32

About The Position

Overall Purpose The Regional Quality Coordinator Lead oversees and leads the Regional Quality Coordinator team. This role is responsible for developing and implementing strategic initiatives to improve HEDIS and quality outcomes across P3 Health Partners' affiliate groups. The position requires leadership skills, knowledge of Medicare Quality Stars metrics, and the ability to drive operational excellence in support of P3's mission to guide communities to better health. Essential Functions Lead and mentor a team of Quality Operations Coordinators, providing guidance, support, and performance management. Develop and implement strategic plans to improve HEDIS scores, CMS Star Ratings, and other quality metrics across P3 Health Partners' network. Collaborate with market VPs and the National Quality Manager to align quality initiatives with organizational goals and objectives. Collaborate on execution of quality improvement projects, including Quality Fairs, Diabetic Days, and other P3 events. Provides telephonic outreach to patients, providers, and pharmacies to discuss opportunities for optimizing medication use or other opportunities for improvement of healthcare performance measure related issues. Participates in data collecting through medical records and claims surveillance. Prepares Quality information for presentation to affiliate groups, including groups current standings relative to others and opportunities or improvement. Serve as the primary liaison between the Quality Operations team and other departments, ensuring effective cross-functional collaboration. Manage relationships with providers and other external stakeholders to drive quality improvements and ensure compliance with quality standards. Develop and maintain standard operating procedures for quality operations, ensuring consistency and efficiency across the team. Lead regular team meetings and participate in Quality Management meetings to review progress, address challenges, and share best practices. Stay current with industry trends, regulatory requirements, and best practices in healthcare quality management. Provide regular reports and presentations to National Quality leadership on quality performance. Ensure compliance with HIPAA, CMS, NCQA, and other relevant regulatory requirements. Continuously evaluate and optimize the use of technology and data analytics to improve quality outcomes. Other duties as assigned by senior leadership. Knowledge, Skills, and Abilities Deep understanding of HEDIS Technical Specifications, CMS Star Ratings, and Medicare Quality benchmarks. Comprehensive knowledge of HIPAA regulations, CMS guidelines, and NCQA standards. Understanding of managed care operations, provider network structures, and clinical workflows within primary care settings. Knowledge of medical record retrieval, claims data analysis, and surveillance techniques used to validate quality gaps. Ability to supervise, mentor, and manage the performance of a team of Quality Operations Coordinators. Exceptional verbal and written communication skills for presenting data to leadership, conducting telephonic outreach to patients/providers, and collaborating with cross-functional departments. Proficiency in interpreting complex data sets to identify trends, gaps in care, and opportunities for improvement; ability to present this data clearly to affiliate groups. Advanced skills in Microsoft Office Suite (Excel, PowerPoint, Word, Access) and SharePoint for data management and collaboration. The ability to drive efficiency and consistency by developing and maintaining Standard Operating Procedures (SOPs). The ability to stay current with evolving industry trends and regulatory changes and adjust strategies accordingly. The capacity to identify barriers to quality improvement (e.g., low HEDIS scores) and innovate solutions to overcome them. A demonstrated commitment to P3’s mission of guiding communities to better health, including comfort with direct patient outreach. The ability to work independently, manage multiple priorities, and execute tasks assigned by senior leadership with minimal supervision.

Requirements

Deep understanding of HEDIS Technical Specifications, CMS Star Ratings, and Medicare Quality benchmarks.
Comprehensive knowledge of HIPAA regulations, CMS guidelines, and NCQA standards.
Understanding of managed care operations, provider network structures, and clinical workflows within primary care settings.
Knowledge of medical record retrieval, claims data analysis, and surveillance techniques used to validate quality gaps.
Ability to supervise, mentor, and manage the performance of a team of Quality Operations Coordinators.
Exceptional verbal and written communication skills for presenting data to leadership, conducting telephonic outreach to patients/providers, and collaborating with cross-functional departments.
Proficiency in interpreting complex data sets to identify trends, gaps in care, and opportunities for improvement; ability to present this data clearly to affiliate groups.
Advanced skills in Microsoft Office Suite (Excel, PowerPoint, Word, Access) and SharePoint for data management and collaboration.
The ability to drive efficiency and consistency by developing and maintaining Standard Operating Procedures (SOPs).
The ability to stay current with evolving industry trends and regulatory changes and adjust strategies accordingly.
The capacity to identify barriers to quality improvement (e.g., low HEDIS scores) and innovate solutions to overcome them.
A demonstrated commitment to P3’s mission of guiding communities to better health, including comfort with direct patient outreach.
The ability to work independently, manage multiple priorities, and execute tasks assigned by senior leadership with minimal supervision.
Experience with HEDIS Technical Specifications, guidelines, reporting and HEDIS survey process
Experience in Project Management
Experience utilizing various software packages including SharePoint, Excel, Access, PowerPoint and Word
Minimum of 3 years in a healthcare environment
Experience managing people
Experience communicating with providers and provider offices
Bachelor’s degree in a related field, master’s preferred

Responsibilities

Lead and mentor a team of Quality Operations Coordinators, providing guidance, support, and performance management.
Develop and implement strategic plans to improve HEDIS scores, CMS Star Ratings, and other quality metrics across P3 Health Partners' network.
Collaborate with market VPs and the National Quality Manager to align quality initiatives with organizational goals and objectives.
Collaborate on execution of quality improvement projects, including Quality Fairs, Diabetic Days, and other P3 events.
Provides telephonic outreach to patients, providers, and pharmacies to discuss opportunities for optimizing medication use or other opportunities for improvement of healthcare performance measure related issues.
Participates in data collecting through medical records and claims surveillance.
Prepares Quality information for presentation to affiliate groups, including groups current standings relative to others and opportunities or improvement.
Serve as the primary liaison between the Quality Operations team and other departments, ensuring effective cross-functional collaboration.
Manage relationships with providers and other external stakeholders to drive quality improvements and ensure compliance with quality standards.
Develop and maintain standard operating procedures for quality operations, ensuring consistency and efficiency across the team.
Lead regular team meetings and participate in Quality Management meetings to review progress, address challenges, and share best practices.
Stay current with industry trends, regulatory requirements, and best practices in healthcare quality management.
Provide regular reports and presentations to National Quality leadership on quality performance.
Ensure compliance with HIPAA, CMS, NCQA, and other relevant regulatory requirements.
Continuously evaluate and optimize the use of technology and data analytics to improve quality outcomes.
Other duties as assigned by senior leadership.