Medicare Advantage Quality Consultant - CPA Market

We need to output only HTML fragment, using

for section headings: About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule. We must include only sections that have real specific content. The posting includes: Job Summary (could be About the role). Essential Responsibilities (Responsibilities). Education (Qualifications? maybe Education under Qualifications). Licenses or Certifications (maybe Qualifications). Experience (Qualifications). Skills (Skills). Travel Requirement (maybe Schedule? Actually travel requirement is not schedule; but we have no explicit schedule or pay/benefits. There's no pay or benefits info. So we should not create Pay/Benefits/Schedule sections unless present. There's Travel Requirement 50% - 75% (maybe schedule? but it's travel, not schedule). The instruction: include a section ONLY when posting has real, specific content for it. So we can have sections: About the role (job summary), Responsibilities, Qualifications (education, licenses, experience), Skills. Possibly also a section for Travel? Not in list of allowed headings; only allowed headings are those listed. So we cannot create a custom heading like Travel. We could fold travel into Responsibilities or About the role? Probably include in About the role as a sentence. But we must not invent sections. So we will output:

About the role

... job summary ...

Responsibilities

• ... each essential responsibility ...

Qualifications

• Education: Required Bachelor's Degree ... Substitutions ... Preferred Master's Degree ...
• Licenses or Certifications: Required None Preferred None
• Experience: Required 5 years in Medicare/Medicaid ... 3 years in data analysis ... Experience with Medicare STARS ... Preferred 7 years ... Experience in Lean, Six Sigma ... Experience in health plan provider network performance management ...

Skills

• Must be able to effectively resolve issues ...
... etc.

We must preserve all substantive information; do not invent or summarize away detail. Need to include all bullet points from responsibilities, education, licenses, experience, skills. Also include Travel Requirement and Language Requirement maybe within About the role or Responsibilities? Probably include in About the role as a note. Also include Physical, Mental Demands and Working Conditions? Not in allowed headings; we could fold into About the role or Responsibilities? Probably include in About the role as a paragraph. But we must not create extra headings. So we can add a

after About the role that includes travel requirement, language requirement, physical demands etc. However the instruction: "Use

for section headings (e.g. About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule)." It says e.g., meaning those are examples; we can use those headings. It doesn't forbid other headings? It says use

for section headings (e.g. About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule). Likely they expect only those headings. So we should stick to those. We can put travel requirement etc. in About the role paragraph. We must remove boilerplate: disclaimer, compliance requirement, EEO, etc. Also remove navigation, cookie, legal, EEO, scam-warning, duplicated lines. Also remove application instructions (none present). Also remove "Disclaimer", "Compliance Requirement", etc. We need to preserve all substantive information: job summary, essential responsibilities, education, licenses, experience, skills, travel requirement, language requirement, physical/mental demands/working conditions? Those are substantive; we should include them somewhere. Since we cannot create a new heading, we can include them in About the role or Responsibilities. Probably About the role is appropriate for general description; we can add a paragraph after the summary that includes travel requirement, language requirement, physical demands, working conditions. Let's extract the substantive content: Job Summary (first paragraph): "This job is directly responsible for the value creation, impact and cost control and fiscal/ROI targets as set by the Organization, including revenue stream outcomes, and engagement of primary care providers (PCP) enrolled in government value-based reimbursement programs and continuous improvement models. This job is a highly skilled subject matter expert (SME) in Medicare STARS, Medicaid HEDIS and risk revenue streams and provides strategic, hands-on, office based support to PCPs for analysis of performance Medicare STARS, Medicaid HEDIS and risk revenue streams, identifies opportunities for improvement in value creation, cost control and utilization, performance, and develops strategic plans in collaboration with PCPs and the inter-departmental teams for transformation of workflows resulting in outstanding performance in government program(s) ensuring that ROI targets set by the Organization are met or exceeded. Further, in a matrix management environment, the Medicare Advantage Quality Consultant is responsible for collaborative work with other functions in the provider area, data analytics, and key internal/external stake holders to provide the most appropriate support to the PCPs based upon data analysis and dashboard reports." Essential Responsibilities list: multiple sentences; we need to break into bullet points. Let's parse: - Directly responsible to provide office based, hands-on assistance services (i.e., chart reviews, mass claims adjustments, UDC processes, etc.) to PCPs enrolled in Medicare STARS, Medicaid HEDIS and risk revenue programs and clinical evidence-based guidelines. - The Medicare Advantage Quality Consultant is expected to assess the needs of each individual PCP practice, and use a combination of on-site individual office based, entity level based, video conference, teleconference, and electronic mail interactions to drive engagement and exemplary value creation, impact and cost control, and ROI/fiscal outcomes as set by the Organization for government programs. - Directly responsible to analyze and interpret data in government value-based reimbursement reports in the areas of Medicare STARS, Medicaid HEDIS and risk revenue and develop strategic plans to meet PCP government program targets to create value, impact, and cost savings, as well as meeting the ROI as identified by the Organization. - Directly responsible to assess data for highest ROI opportunities in PCP performance and implement strategic plans to meet identified program targets across all the Organization's value-based programs for both the commercial and government business (ACA, Medicare STARS, Medicaid HEDIS, risk revenue). - Function as the Organization's representative subject matter expert in government value-based reimbursement programs and data analysis. This includes presentation of program results to both internal and external audiences, including practice and entity meetings. - Participates in the development and presentation of instructional materials for internal and external audiences. - Provide assistance to PCPs in the use of user interfaces, predicative analytic tools, and other population health management tools endorsed by Highmark. - Independently and autonomously manage PCP caseloads, projects, meetings, deliverables, resources etc. for individualized strategic plans to transform PCP practices enrolled in government programs using innovative continuous improvement methodologies. This includes cross training in all of Highmark’s value-based reimbursement programs to lend support as needed/defined by market outcomes. - Serve as the clinical subject matter expert for PCP Medicare STARS, Medicaid HEDIS, and risk revenue programs for both internal and external Highmark key stake holders. In a matrix management environment, works collaboratively with the interdepartmental team to provide the most comprehensive support to PCPs for exemplary scores in government programs. - Other duties as assigned or requested. Education: - Required Bachelor's Degree in a clinical or healthcare related field - Substitutions: 6 years of relevant experience in lieu of a Bachelor's Degree - Preferred Master's Degree in a clinical or healthcare related field Licenses or Certifications: - Required None - Preferred None Experience: - Required 5 years in Medicare/Medicaid and risk revenue, primary care and the ambulatory care environment, healthcare insurance industry government programs, healthcare administration in primary care, or healthcare consulting in government programs for primary care - 3 years in data analysis, interpretation, and outcomes strategic plan development - Experience with Medicare STARS, Medicaid HEDIS, risk revenue value streams, and population health management - Preferred 7 years in a government program setting, managed care, primary care management or other clinical setting - Experience in Lean, Six Sigma, TQI, TQC or other quality management certification - Experience in health plan provider network performance management, population health management, continuous improvement or provider engagement models Skills: - Must be able to effectively resolve issues and problems across all areas of the corporation, by understanding corporate strategies, policy and scope of authority - Because of the broad impact of decisions that are made, must be knowledgeable and sensitive to many internal and external corporate issues - Aptitude for a high visibility position demanding integrity, uncompromising professionalism, diplomacy and conflict management - Demonstrates a deep understanding of primary care practice operations and workflow across the continuum of variability in primary care and experience in managing provider and administrative leadership relationships - Superior written and verbal communication skills and listening skills - Ability to adapt engagement strategies to meet market needs - Travel Requirement 50% - 75% - Language Requirement (other Than English) None Physical, Mental Demands and Working Conditions: - Position Type Office-Based - Teaches/Trains others regularly - Constantly Travels regularly from the office to various work sites or from site-to-site - Frequently Works primarily out-of-the office selling products/services (Sales employees) Does Not Apply - Physical Work Site Required No - Lifting up to 10 pounds Constantly - Lifting 10 to 25 pounds Rarely - Lifting 25 to 50 pounds Rarely We need to include all that. We can put travel requirement etc. in Skills section (makes sense). Physical demands maybe in About the role or Responsibilities? Could add a paragraph after Skills? But we cannot create new heading. Could add a

after Skills that includes physical demands. That is allowed as prose. The instruction: Use

for prose. So we can have a

after Skills that includes physical demands etc. That is fine. We must not repeat the job title as a heading. The job title is Medicare Advantage Quality Consultant (implied). We won't. We must not put Job ID/requisition numbers as headings; none present. We must remove boilerplate: disclaimer, compliance requirement, EEO, etc. Also remove "The job description has been designed..." etc. Also remove "Compliance Requirement", "Highmark Health and its affiliates prohibit discrimination...", "We endeavor to make this site accessible...", "California Consumer Privacy Act Employees, Contractors, and Applicants Notice". All that. Now craft HTML. We'll have:

About the role

[job summary text]

Responsibilities

• ... each bullet

Qualifications

• Education: Required Bachelor's Degree in a clinical or healthcare related field. Substitutions: 6 years of relevant experience in lieu of a Bachelor's Degree. Preferred: Master's Degree in a clinical or healthcare related field.
• Licenses or Certifications: Required None. Preferred None.
• Experience: Required 5 years in Medicare/Medicaid and risk revenue, primary care and the ambulatory care environment, healthcare insurance industry government programs, healthcare administration in primary care, or healthcare consulting in government programs for primary care. 3 years in data analysis, interpretation, and outcomes strategic plan development. Experience with Medicare STARS, Medicaid HEDIS, risk revenue value streams, and population health management. Preferred: 7 years in a government program setting, managed care, primary care management or other clinical setting. Experience in Lean, Six Sigma, TQI, TQC or other quality management certification. Experience in health plan provider network performance management, population health management, continuous improvement or provider engagement models.

Skills

• Must