HEDIS Quality Risk Specialist

HEDIS Quality Risk Specialist

AmeriHealth Caritas | Newtown Square, PA, 19073, US

Posted 13 days ago

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**HEDIS Quality Risk Specialist**

Location: Newtown Square, PA

Primary Job Function: Medical Management

ID**: 25070

Your career starts now. We're looking for the next generation of health care leaders.

At AmeriHealth Caritas, we're passionate about helping people get care, stay well and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we'd like to hear from you.

Headquartered in Philadelphia, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more about us at www.amerihealthcaritas.com .


The role will be responsible for analyzing, developing, maintaining, and implementing documentation to execute the knowledge and skills development related to quality improvement, HEDIS and risk adjustments. The HEDIS Quality and Risk Specialist will work as a liaison to business teams to evaluate knowledge gaps, design program materials and implement solutions to close knowledge gaps. Internally, this role will partner with business and training leaders across the organization to develop professional level presentations, program guides and job aids that optimize and drive business outcomes at all levels of the organization. Externally, this role will partner with the provider network transformation team to support training and program integration, as it relates to quality and risk adjustment requirements and metrics. The following are core tasks included but are not limited to the job responsibilities:

+ Develop and implement program materials to deliver the required knowledge for internal and external business teams, including but not limited to HEDIS Strategy & Analytics, Quality Management, Provider Network Management, and external stakeholders.

+ Oversee and maintain program effectiveness and materials utilized by internal and external business teams, including but not limited to HEDIS Strategy & Analytics, Quality Management, Provider Network Management, and external stakeholders.

+ Create training and program modules to support dissemination of materials and information to external stakeholders.

+ Working as a liaison, partnering with management teams to track and define program knowledge and the risk gaps within their teams and define appropriate approaches to increase knowledge and close gaps.

+ Create and implement a strategic approach to evaluate overall HEDIS and Quality and risk knowledge gaps.

+ Ensure all collateral materials meet the standards of quality improvement programs designed to achieve quality, utilization, population health, health disparities and contractual metric goals.

+ Develop and implement new program material to close knowledge gaps related to quality, HEDIS and risk. Must be able to communicate materials and program requirements at all levels of the enterprise.

+ Attend business meeting to ensure understanding of knowledge gaps and analyze data to adjust program documentation as required.

+ Implement the appropriate program level evaluation criteria to determine and make necessary adjustments to program materials to meet business outcomes.

+ Develop schedule and conduct web-based trainings to support quality, HEDIS and risk adjustment enterprise level improvement.

+ Analyze trends and evaluate potential barriers, gaps and opportunities to improvement effectiveness.

+ Maintain technical knowledge of quality, HEDIS and risk programs.

+ Maintain a day-to-day working knowledge of all quality, HEDIS and risk programs and the quality metrics in which the company participates.

+ Deliver in-person and virtual learning session to a variety of audience levels, assessing and using the most appropriate communication vehicle.

+ Partner with other training teams to provide train-the-trainer program sessions to ensure consistent application of program materials in new hire training.

+ Maintain working knowledge of appropriate training knowledge, skills and aptitude to ensure all presentations, train-the-trainer, program sessions are effective.

+ Serve as an SME on the design and delivery of all quality and HEDIS training programs.

+ Maintain appropriate time management in all areas of the program's design, delivery, and management of day-day operations of quality, HEDIS and risk.

+ Partner with Corporate Learning Governance to ensure all learning required to be tracked adheres to ACFC instructional design principles and learning management system guidelines.

**Education & Experience:**

+ Bachelor's Degree or equivalent experience in clinical program design and training.

+ Master's Degree (preferred)

+ Minimum 5 years' experience and knowledge of clinical quality, HEDIS and risk programs.

+ At least 3 years' experience facilitating and presenting information in a classroom and webinar environment; clinical experience preferred.

+ At least 3 years' experience creating presentations and programs materials; experience with online content preferred.

+ Knowledge of Clinical Quality and HEDIS metrics, required

+ Excellent written and verbal communication

+ Strong collaboration skills/teamwork

+ Problem Solving and Decision making skills

+ Technical Agility to learn new software and systems, as needed, required

+ Strong MS Office Suite, required

+ Knowledge Adult learning theories, required

+ Experience with instructional program development tools, preferred

EOE Minorities/Females/Protected Veterans/Disabled