This is a remote work from home position

There are 2-4 onsite meetings annually

Monday - Friday 0800-1630

Must have High Speed Internet

Preferred candidate will have 5 years in quality improvement experience in a healthcare environment.

Major Responsibilities:

• Coordinates, facilitates and implements best practices strategies for assigned patient populations to meet accreditation, quality and cost goals. Provides quality assurance on all aspects of implementation of Population Health Services in conjunction with external and internal implementation representatives.
• Collaborates with the management team to develop and maintain an ongoing quality management program for Population Health Services in accordance with regulatory requirements and client contractual agreements.
• Responsible for the development and implementation of indictors of operating thresholds for quality and productivity, development and delivery of management reports, development and implementation of corrective action or quality improvement plans and ensures appropriate dispute resolution procedures are in place.
• Conducts focused accreditation audits of cases completed by the Aurora Population Health Services team and provides feedback to audit staff. Provides statistical reports to manager regarding results of audits.
• Understands and interprets multiple contracts and contractual obligations in order to enable the Population Health Services team to achieve maximum quality, clinical and financial outcomes.
• Participates in the development of Population Health Services policies and procedures. Communicates the value of the Aurora Accountable Care Network and Aurora's integrated delivery system.
• Maintains current knowledge of contracts, applicable departments/organizational policies, procedures, provider listings and NCQA standards. Independently seeks and gains knowledge of organizational and industry issues and changes as they pertain to this role.
• Establishes and maintains relationships with external partners (employer, sales team, payers/third party administrators, etc.) and internal partners to improve the overall quality and efficiency of care provided to health plan members. Collaborates with nursing and/or patient education, physicians, providers and staff to review, design, and coordinate the use of patient education materials.
• Plans, implements and evaluates educational opportunities based on identified needs assessment and requests, results of activities, new technology, healthcare trends, regulatory agency requirements, strategic planning, patient populations, scopes of service, and care management priorities. Ensures consistency, quality, and evaluates educational programs for staff and patients ensuring quality and cost effectiveness.
• Drives development of improved Electronic Health Record tools to support Population Health Services in collaboration with key functional departments and leadership.

Licensure, Registration, and/or Certification Required:

• Registered Nurse license issued by the state in which the team member practices.

Education Required:

• Bachelor's Degree in Nursing.

Experience Required:

• Typically requires 5 years of experience in quality improvement experience in a healthcare environment.

Knowledge, Skills & Abilities Required:

• Advanced knowledge of regulations and standards for health plan administration accreditation/delegation.
• Demonstrated leadership abilities to include project/staff coordination. Experience with planning and implementing complex projects.
• Strong written and oral communication skills with ability to concisely communicate with key leaders. Ability to establish goals, priorities, and ensure team members understand work assignments.
• Highly motivated, organized, self-starter with a focus on delivery of key project objectives.
• Demonstrated effective interpersonal skills and evidence of being a strong team player. Possesses a strong orientation toward customer service, innovation and new ideas.
• Strong facilitation and persuasion skills; capable of influencing project team members to achieve goals.
• Ability to work and remain flexible in a dynamic environment with multiple dependencies, departments and projects. Ability to set priorities and accomplish assignments in a thorough and timely fashion.
• Demonstrated knowledge of the evolving health care delivery environment, health claims processing, medical management, and the health plan sales process.
• Proficient knowledge in the use of Microsoft Office (Excel, PowerPoint and Word) or similar products.

Physical Requirements and Working Conditions:

• Must be able to perform fine hand manipulation when using computer keyboard.
• Exposed to a normal office environment the majority of the time.
• Position requires occasional travel. May be exposed to road and weather hazards.
• Operates all equipment necessary to perform the duties of the job.

This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.