Quality and Performance Consultant
Core
Analyze quality results, coordinate Quality of Care case intake and triage, conduct focus audits, and draft reports to address trends and quality concerns in health insurance operations.
Role type
Quality and Performance Consultant (Healthcare Operations)
Builds
Quality improvement initiatives, case documentation, and performance reports for health insurance lines of business.
Domain
Health Insurance / Healthcare Quality Management
Deliverable
dashboards & analysis
Required skills
Claims processing, contract and benefit administration, quality assessment, process improvement, problem claims resolution, meeting facilitation, regulatory compliance knowledge
Preferred skills
Healthcare systems proficiency (MHK, Facets, Salesforce Health Cloud, DentaQuest, EPIC), case triaging, stakeholder collaboration, medical records management, CMS/NCQA/HEDIS knowledge, Medicare/Medicaid program experience
Technologies
MHK, Facets, Salesforce Health Cloud, DentaQuest, EPIC, Microsoft Office (Excel, Word, Outlook)
Responsibilities
Complete trending and analysis of quality results; coordinate Quality of Care case intake, triage, tracking, and assignment; conduct assigned focus audits; draft executive summary documents and case-related reports; facilitate meetings with internal business partners; consult on items impacting quality performance; evaluate quality programs with operational areas; maintain case documentation and medical record requests.
Seniority
Mid-level, hands-on IC