Quality Improvement Specialist, Sr

Health Net, Inc. (NYSE: HNT) is among the nation's largest publicly traded managed health care companies. Health Net's mission is to help people be healthy, secure and comfortable. The company's POS, HMO, insured PPO, behavioral health and government contracts subsidiaries provide health benefits to more than 7 million individuals. For more information on Health Net, Inc., please visit the company's Web site at www.healthnet.com

JOB SUMMARY:

The Senior Quality Improvement Specialist is responsible for coordinating assigned regulatory, accreditation, clinical quality and/or service improvement programs. Functions as a leader for assigned health services initiatives handling multiple large-scale complex initiatives. Collaborates on national, regional and multi-plan initiatives. Develops programs in compliance with accreditation and regulatory requirements/ standards and monitors ongoing program performance to maintain compliance. Acts as a resource for training, policy and regulatory/accreditation interpretation.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

• Leads and manages multiple complex initiatives that impact the quality or effectiveness of health care delivery and/or health care services provided to members, ensuring compliance with accreditation and regulatory requirements.
  
• Provides an assessment of programs, initiatives and interventions to determine the effectiveness of activities and makes recommendations to improve outcomes.
  
• Develops targeted activities to improve HEDIS, CAHPS, provider satisfaction and other identified performance measures.
  
• Completes project-related communication, including member/physician mailings, business plans, graphics, minutes and agendas.
  
• Monitors and analyzes outcomes to ensure goals, objectives, outcomes, accreditation and regulatory requirements are met.
  
• Participates in departmental evaluation, audit and improvement activities.
  
• Leads, facilitates or participates in relevant committees and work groups; makes presentations; prepares reports, data or other materials for committee presentation.
  
• Identifies areas of improvement within the company and works collaboratively with other departments to develop clinical and non-clinical performance improvement projects.
  
• Researches best practices, national and regional benchmarks, and industry standards. 
  
• Ensures that clinical and service quality improvement standards are compliant with accreditation, state and federal requirements. 
  
• Interfaces with contracted providers or provider groups to promote participation in quality improvement collaboratives to improve clinical care outcomes, health care service utilization and costs.
  
• Represents Health Net at external work groups and committees.  May lead and/or participate in external activities, work groups or committees when applicable.
  
• Communicates programs, interventions and results to external entities in accordance with applicable program objectives, policies and procedures.
  
• In conjunction with medical director, communicates quality improvement initiatives, results, and/or performance data to participating physician groups.
  
• Develops and/or maintains relationships with other external organizations to expand key partnerships.
  
• Assess current industry trends and regulations for enterprise-wide adoption to assure quality and effectiveness of health care delivery and/or healthcare services provided to members.
  
• Performs all other duties as assigned.
  

REQUIREMENTS:

Education: 

Bachelor's Degree with Registered Nurse License or Master's Degree in related health field (i.e. MPH or MPA)

Certification/License: 

Valid state of California Registered Nurse license preferred

Experience: 

• Minimum two years clinical experience with clinical degree program
  
• Three to five years managed care experience
  
• Experience in compliance, accreditation, service or quality improvement
  
• Complex project management experience 
  

Knowledge, Skills & Abilities:  

• Knowledge of accreditation, federal and state regulations/requirements
  
• Knowledge of research methodology and design
  
• Analytical and problem solving skills
  
• Verbal and written communication skills
  
• Team player who builds effective working relationships
  
• Ability to work independently
  
• Organizational skills
  
• Facilitation skills
  
• Personal computer skills with knowledge of Microsoft Office software including proficiency in Word, Excel, PowerPoint, Access and Project
  
• Ability to analyze, interpret, apply and communicate policies, procedures and regulations
  

OR Any combination of academic education, professional training or work experience, which demonstrates the ability to perform the duties of the position.

Health Net, Inc. supports a drug-free work environment and requires pre-employment background and drug screening. 

Health Net and its subsidiaries are an Equal opportunity/Affirmative Action Employer M/F/V/D.