Network Hospital Quality Coordinator

About the role

Join our team and start a meaningful career where your work supports better health outcomes for Mississippians every day. We are seeking a Network Hospital Quality Coordinator to drive data-driven decision-making which enhances the quality of care provided by Network Hospitals and Providers using the Comprehensive Quality Model and align with regulatory, accreditation, and safety standards.

Responsibilities

• Review data and key performance indicators (KPIs) to identify trends, benchmark against standards and pinpoint areas for improvement.
• Develop, implement and monitor quality improvement projects based on evidence-based practices in alignment with the Comprehensive Quality Model (CQM) and other value-based initiatives.
• Ensure adherence to federal and state regulations, as well as standards from organizations such as Centers for Medicare & Medicaid Services (CMS) and The Joint Commission.
• Conduct audit projects and develop corrective action plans for identified gaps.
• Research methods and best practices for clinical care, recommending updates to existing measures to align clinical best practice research and reimbursement programs.
• Present actionable data to improve performance, build trust and enhance public brand.

Requirements

• Bachelor’s degree in a business-related field, or clinical designation, such as R.N.
• Five years of healthcare administration and/or clinical experience.
• Experience analyzing and trending healthcare related data.
• Experience in the development and implementation of provider/hospital quality improvement programs and activities intending to monitor/improve health related outcomes.
• Proficiency using Microsoft Word and Excel.
• Ability to work when required, on a flexible schedule and with moderate travel.
• Working knowledge and expertise of healthcare quality, particularly as it relates to providers.
• Strong interpersonal skills to build solid business relationships and collaborate with diverse teams including medical providers, frontline staff and those from other Blue Plans or Blue Cross Blue Shield Association.
• Ability to manage and maintain confidentiality of information.
• Strong verbal and written communication skills to ensure that documents and reports are accurate, detailed and clear, using proper medical terminology to prevent life-threatening misinterpretations.

Preferred

• Master’s degree in healthcare administration or nursing.
• Experience with Microsoft Access and Visio.
• Knowledge of accreditation programs such as The Joint Commission, Det Norske Veritas (DNV) and National Committee for Quality Assurance (NCQA).
• Knowledge of value-based programs such as Bundled Payments for Care Improvement (BPCI) and Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).
• Knowledge of Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), International Classification of Diseases, Tenth Revision (ICD10), Uniform Billing (UB) Revenue and National Drug Code (NDC) coding.
• Knowledge of High Reliability Organizations’ quality improvement methodologies and/or certification in quality process improvement.

Why Join Us

Purpose-Driven Work: Make a meaningful impact on the Health & Wellness of our Members.
Learning & Development: Build foundational knowledge in finance and investment accounting.
Career Growth: Clear pathways to grow your career where your skills flourish, including Treasury, Financial Reporting, Accounting Operations, Internal Audit, etc.
Healthy Culture: Work in an environment with a focus on your health which allows you to thrive.
Compensation & Benefits: We offer a highly competitive compensation package that includes medical benefits, 401(k), ample paid time off and a schedule that supports true work/life balance.