Quality Coordinator

Job Summary
**Hybrid Work Environment - Must reside in Hawaii**
Pay Range: $57,629 - $88,159
Note: Individuals typically begin between the minimum to middle of the pay range
The Quality Coordinator is a self-driven individual and instills a passion for driving excellence and supporting a culture of quality. Based on assignment and under minimal direction of management, they will utilize their business acumen, acquire process, program knowledge, and apply logic and analytical skills to support program operation activities and initiatives that will improve or enhance program administration delivered to plan beneficiaries, providers and operational staff.
The Quality Coordinator will perform a variety of complex tasks to include maintaining compliance with NCQA standards and other regulations as they apply to the programs, survey administration, identification of issues and corresponding facilitation and implementation of initiatives and resolutions to increase program efficiency, develop or revise appropriate documentation, data analysis and report creation and presentation. Working in partnership and collaboratively with staff, managers and leadership to achieve targeted goals, objectives and outcomes are keys to success in this role.
Minimum Qualifications

1. Bachelor's degree and three years of related work experience; or an equivalent combination of education and related work experience.
2. Effective verbal and written communication skills
3. Proficient analytical or critical thinking skills, such as logical reasoning, problem solving, researching, and creativity.
4. Intermediate working knowledge of Microsoft Office Word, Outlook, Excel.
5. Basic working knowledge of Microsoft Office PowerPoint and Visio.

Duties and Responsibilities

1. Serves as NCQA subject matter expert, ensures health plan compliance and support as it relates to department programs and activities.
   
   • Initiate, facilitate and coordinate quality improvement activities and metrics to support assigned NCQA standards and requirements.
   • Proactively keep all staff updated on NCQA standards and application, through notifications of change, workflow and documentation updates, and training.
   • Analyze, promote, and implement updates to department operations to effectively support health plan accreditation.
   • Conduct quality monitoring and auditing of system documentation to include member records.
   • Partner with Quality Management team to support health plan NCQA accreditation.
   • Complies with timelines and deadlines.
   • Create, revise, and maintain all supporting documentation, including program descriptions, reports, work instructions, workflows and policies.
   • Provides quality update at Quality Improvement committees to include Case Management Committee.
   • Support staff training with the assistance of department trainer.
   • Performs case management delegation oversight activities of providers in collaboration with Delegation Quality Coordinator.
2. Member satisfaction survey administrator.
   
   • Oversee administration of department member satisfaction surveys for multiple clinical programs by ensuring survey workflow consistently continues, barriers are removed, and deadlines are met.
   • Facilitate print/mail workflow with administrative and IT services.
   • Validate data and process flow.
   • Prepare file for mail merge by administrative support team.
   • Maintain master data collection file.
   • Quality assurance monitoring through system documentation.
   • Prepare monthly report to managers.
   • Share member feedback with staff.
   • Research negative comments and low scored responses.
   • Partner with Corporate Analytics for data analysis.
   • Support staff training with the assistance of department trainer.
   • Identify opportunities for improvement, facilitate implement interventions.
3. Reporting, Data, and Analytics
   
   • Prepares reports and presentations to educate and communicate information and results related to metrics, requirements, operation audit trends, project and quality improvement activities. Duties include, but are not limited to:
     
     • Program evaluations
     • Outcome summaries
     • Identifies, coordinates and participates in quality monitoring and improvement opportunities to improve program performance, facilitate change, and take action to implement ideas.
     • Takes initiative to research issues, conduct root cause analysis, documents
4. Program Operations
   
   • Targeted member communications: Identify target population and develop maintain communication material for initiative and program communication via mailing and alternative communication channels.
   • Create, update, and maintain: Program descriptions, Policies procedures, workflows, work instructions, reference documents and, operational manuals.
   • Oversee maintenance and accuracy of online material related to department programs.
5. Delegation
   
   • Serves as additional support and back-up to delegation point and activities such as:
     
     • Host facilitate meetings with provider organizations.
     • Chart audit activities
     • Program evaluations
     • General program support such as material/correspondence reviews, billing/invoice workflow, report development presentations.
6. Performs all other miscellaneous responsibilities and duties as assigned or directed.
   
   • Assists with special projects and department priorities/initiatives.
   • Support staff operations to ensure daily operations continue.

#LI-Hybrid