Clinical Quality Consultant

About the role

This position reports to the Senior Director of Quality in the Massachusetts Community Plan and plays a key role in advancing quality performance, health equity, and member outcomes. The role leads quality improvement initiatives, analyzes healthcare data, and partners across the organization to drive performance on HEDIS, Star Ratings, CAHPS, and state quality programs. Responsibilities include the development, implementation, monitoring, and evaluation of quality improvement programs and interventions that support performance on state and federal quality measures, regulatory requirements, and organizational objectives.

If you are located within a commutable distance to Newton, MA you will have the flexibility to work remotely as you take on some tough challenges. Must be able to work EST hours 8am until 5pm.

Responsibilities

• Lead the development, implementation, evaluation, and reporting of the Massachusetts Community Plan's Five-Year Health Equity Strategic Plan
• Design, implement, and evaluate quality improvement strategies to improve performance on Medicare Star Ratings, HEDIS®, CAHPS®, and state-mandated quality measures
• Develop understanding of customer requirements and/or expectations and anticipate needs to determine appropriate course of action
• Interpret and apply regulatory, accreditation, and contractual requirements, including NCQA, CMS Star Ratings, HEDIS, CAHPS, and EOHHS standards
• Collaborate across clinical, operational, provider, and corporate teams to drive quality initiatives, resolve issues, and achieve performance goals
• Prepare and present quality performance results, strategic initiatives, and recommendations to leadership, state agencies, and other key stakeholders

Required Qualifications

• 5+ years of experience leading healthcare quality improvement initiatives
• 5+ years of experience with analyzing and interpreting healthcare data
• 5+ years of healthcare experience with managed care, health plans, provider organizations, or a related healthcare setting
• Intermediate level of proficiency in Microsoft Office - Outlook, Word, PowerPoint, and Excel
• Willing to commit to improving health outcomes and advancing health equity
• Willing and able to commute to Newton, MA as needed

Preferred Qualifications

• Certified Professional in HealthCare Quality (CPHQ)
• Experience working in an outpatient clinical setting
• 5+ years of experience with HEDIS measures, NCQA, and CMS Star Ratings
• Active RN license
• Experience with Medicaid and/or Medicare managed care programs
• Experience developing and implementing health equity programs and interventions

Soft Skills

• Strong analytical and critical thinking skills
• Excellent written, verbal and presentation skills
• Ability to work independently with minimal supervision
• Ability to effectively manage multiple priorities and projects simultaneously
• Ability to influence and collaborate within a highly matrixed organization
• Strong collaboration and relationship-building skills
• Have limited distractions in the work environment

Pay

The salary for this role will range from $91,700 - $163,700 annually based on full-time employment. We comply with all minimum wage laws as applicable.