Manage the internal and external quality improvement (QI) for the department to continuously improve the quality and efficiency for members, providers and populations we service. Coordinate communication of QI activities among stakeholders. Maintain compliance with standards of external accrediting and regulatory agencies. Maintenance of Disease Management NCQA certification. Utilizes analytical tools to identify opportunities for quality improvement. Utilizes lean thinking to identify solutions. Incorporates new quality findings into staff development initiatives for staff. Creates an environment that fosters teamwork, emphasizes quality, recognizes internal and external customers and promotes learning. Is a strategic partner with management team to support best practices.
Minimum Requirements: A Bachelor's Degree in Nursing (BSN) from an accredited nursing education program or, equivalent experience in a quality management or compliance role is required. A minimum of three (3) years of recent experience in program evaluation in a health insurance, population health, corporate health, and/or community health setting is required. Must have a minimum of one (1) year of experience in quality management, accreditation, and/or regulatory and compliance. Computer literacy and advanced proficiency in Microsoft Office Suite including Excel, Word, PowerPoint, and Outlook. Understanding of basic statistical concepts and their application. Database skills (statistical concepts, data management, variance analysis). Exhibits skills in health information fundamentals including application of basic statistical concepts, data. Ability to organize and report data with graphics, charts and descriptive analysis. Excellent time management skills required. Possesses excellent written and verbal communication skills applicable in both individual and organizational development. Ability to work as a change agent to influence member, staff and provider decisions. Critical thinking, problem solving and decision- making skills. Ability to prioritize multiple competing projects. Detail-oriented. Ability to function independently and follow direction as needed with minimal redirection. Skill set to include clinical expertise, and business acumen. Demonstrates ability to self-evaluate and exhibits high level of emotional intelligence. Excellent customer service and advocacy skills to assure quality is the focus of organizations efforts. Solid research skills to support analytical and quality efforts
Preferred Qualifications: Five (5) years recent experience in a health care program evaluation and/or quality improvement role; Master’s degree in Nursing, Public Health, or other related field; Certified Professional in Healthcare Quality (CPHQ) OR certification obtained within two years of tenure in the role; ability/willingness to maintain this credential during tenure in this position; Familiarity with data analytics tools and predictive modeling; Familiarity with Milliman Care Guidelines (MCG); Project management and performance improvement experience and/or LVHN Lean certification; Familiarity with Six Sigma and Lean concepts; Experience with or interest in writing and reviewing health information for plain language; Experience with electronic medical records (EMRs) or other health insurance portals/systems; Experience in policy and procedure development and maintenance.
Internal Number: 2505
About Lehigh Valley Health Network
At Lehigh Valley Health Network (LVHN), we continually go the extra mile to fulfill our mission to heal, comfort and care for the people of our community. Each one of our more than 18,000 colleagues contributes to this mission and helps make the Lehigh Valley a healthier – and better – place in which to live.