GENERAL SUMMARY
Responsible for ensuring compliance with Coventry’s quality improvement programs to ensure program, accreditation, and regulatory standards are met.
ESSENTIAL RESPONSIBILITIES
- Performs quality improvement studies as they relate to trends identified via utilization review activities, utilization patterns, audits, Healthcare Effectiveness Data and Information Set (HEDIS) results, appeals, etc.
- Maintains accurate documentation of all quality improvement activities, i.e., studies, surveys, audits, etc. Performs analysis and provides oversight for delegated functions.
- Monitors and ensures follow-up re-evaluation activities take place when deficiencies are identified and recommendations for corrective action have been made.
- Prepares weekly and monthly reports of all quality improvement activities, i.e., studies, surveys, audits, etc.
- Assists management and senior level staff with preparing the annual quality improvement program evaluation and work plan.
- Provides training to members and employer groups regarding preventive health and wellness as they relate to trends identified via review activities and audits.
- Assists in compiling statistics and metrics. Reports results to the Quality Improvement Committee as appropriate.
- May complete an annual review of department policies and procedures and make recommendations for updates based on changing needs or trends.
- Performs other duties as required.
Qualifications:
JOB SPECIFICATIONS
- Bachelor’s degree or equivalent experience.
- Previous (2-4 years) quality improvement experience.
- In-depth knowledge of medical terminology.
- Excellent verbal and written communication skills.
- Demonstrated data analysis and report preparation skills.
- Knowledge of standard software packages required, including Word, Excel, and PowerPoint.
- Valid driver’s license may be required.
Coventry Health Care is an Affirmative Action/Equal Opportunity Employer, and we are committed to building a talented and diverse team.
Job: Professionals
Primary Location: Scottsdale, AZ, US
Other Locations: San Antonio-Texas-United States,Downers Grove-Illinois-United States
Organization: 40010 - First Health Group Corp.
Schedule: Full-time
Job Posting: 2012-11-26 00:00:00.0
Job ID: 1212307