Healthcare Quality Implementations – Integrations Specialist
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Job Description
Healthcare quality specialist supporting CareSource’s market and product implementations and affiliate integrations. Developing RFP content, quality documentation, and readiness deliverables.
Responsibilities:
- Support the Quality function of new business market and product implementations and integrations
- Review and understand current and prospective contracts
- Inform proposal content and identify, collect, and manage documentation for RFPs and other business-related proposals
- Serve as a Quality liaison between the Enterprise Implementation Organization, Enterprise Project Management Organization, and Quality & Performance Organization
- Partner with Quality sub-functions, IT, and IMO to ensure on-time delivery and operational readiness of sustainable business solutions
- Support Epic and Feature development related to new market/product implementations and CSMS affiliate integrations
- Draft governing documents, including QI Program Descriptions, work plans, charters, and policies and procedures
- Support desktop readiness and Go-Live readiness reviews
- Drive continuous quality improvement by incorporating innovative approaches and lessons learned
- Build and maintain relationships with internal and external stakeholders
- Assist Quality & Performance Outcome teams with EQRO and NCQA readiness
- Review RFP opportunities and advise proposal writers on content development
- Review and analyze cross-functional data for RFP and proposal requirements
- Develop and maintain repositories for quality-related internal and external data
- Evaluate state or federal priorities, perform market research, and complete epidemiological studies
- Collect supplemental documentation, appendices, and forms for contracts and proposals
- Proofread and revise proposal documents
- Complete Model of Care SNP documentation, including Population Assessment and Quality Improvement requirements
- Compile success stories and metrics for RFP content
- Collect quality-improvement proposal commitments and coordinate cross-functional implementation
- Support other Quality functional areas in new market and product implementations
- Perform other job-related duties as requested
Requirements:
- Bachelor's degree required
- Equivalent years of relevant work experience may be accepted in lieu of required education
- Five (5) years of Managed Care experience, preferably within Quality Management/Improvement required
- Proficiency in Microsoft Office tools, including PowerPoint, Word, Excel, Teams and Outlook
- Effective listening and critical-thinking skills
- Analytical and timely problem-solving skills
- Interpersonal and relationship-building skills
- Ability to effectively interact with all levels within the organization
- Effective written and verbal communication skills
- Strong knowledge of Managed Care and Quality Management, including NCQA accreditations
- Ability to work independently and within a team environment
- Detail-oriented with strong organizational and time-management abilities
- Current CPHQ certification preferred
- General office environment; may be required to sit or stand for extended periods
- Up to 15% occasional travel may be required
Benefits:
- Bonus tied to company and individual performance may be available
- Substantial and comprehensive total rewards package
- Remote work arrangement
- Equal opportunity and inclusive workplace environment
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