QUALITY IMPROVEMENT ANALYST (ACO)

Prominence Health Plan - McAllen, TX2.5

30+ days agoFull-time
Founded in 1978, Universal Health Services, Inc. (UHS)* is one of the nation’s largest and most respected healthcare management companies, operating through its subsidiaries—acute care hospitals, behavioral health facilities and ambulatory centers nationwide. With more than 74,000 people employed by UHS subsidiaries, UHS’s business strategy is to continue to grow by building or purchasing healthcare facilities across the country, while continuing to strengthen UHS’s well-reputed franchise with its customary exceptional service and effective cost control. Our success is driven by a service philosophy based on integrity, competence, compassion, and a responsive management style. UHS has been recognized as a Fortune 500 company and is listed as one of Fortune’s Most Admired Companies. UHS’s Acute Care Division is comprised of 25 high performing hospitals and several ambulatory care facilities across the nation and prides itself on providing superior patient care.

Prominence Health Plan, established in Reno in 1993 as St. Mary’s Health Plan, was acquired in 2014 by Universal Health Services (UHS), one of Fortune Most Admired Companies.

In addition to the HMO, Prominence Health Plan also offers Point of Service health plans, a preferred health insurance company that offers Preferred Provider Organization (PPO) health plans, and CDS Group Health, a third-party administrator.

We are a fast-growing, rapidly-changing healthcare organization offering the excitement of a start-up with the support of a Fortune 500 company. We are looking for talented, enthusiastic people to help shape the future of our organization.

Job Summary: The Quality Analyst provides oversight & management of Medicare Quality Reporting during each performance year and through the annual reporting periods, including developing & maintaining educational opportunities with physicians, providers, and practice managers within the ACO network. This role is accountable over the ACO annual quality scores, maintains subject matter expertise in annual GPRO measures, develops and leads education on quality initiatives and coaches providers in meeting GPRO measures. This role ensures resources are in place to complete the annual GPRO reporting requirement and oversees any necessary temporary staff to complete data collection and submission.

Regulatory Requirements:
2+ years of experience and knowledge of HEDIS, ACO or Care Gap reporting

Bachelor’s degree in Business Administration, Finance or similar areas, or equivalent work history.

2+ years of experience with Medicare contracts and regulatory reporting requirements

Excellent verbal and written communication and critical thinking skills

Coordinate project activities, track project progress, and provide regular status reporting

Understanding of provider office dynamics and optimal approaches to communicating and educating providers and provider staff

Achieved or pursuing undergraduate level degree

Able to manage and maintain travel between markets

Language Skills:
Ability to effectively communicate in English, both verbally and in writing.

Bilingual Spanish preferred.

Skills:
Excellent communication and relationship skills

Proficient in Microsoft Office (Excel, Word, PowerPoint, etc.)

Enjoys working in both individual and team settings

Problem solver – enjoys problem solving

Self-starter, resourceful and able to execute projects in a fluid and fast paced environment

Strong analytical skills

Attention to detail

High level of energy