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AmeriHealth Caritas Quality Performance Specialist - HEDIS, CAHPS , NCQA Expert in Southfield, Michigan

Quality Performance Specialist - HEDIS, CAHPS , NCQA Expert

Location: Southfield, MI

Primary Job Function: Medical Management

ID**: 19283

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 .


As part of the Quality Management team, the Quality Performance Specialist is responsible for the coordination and ongoing monitoring of QI program objectives, including the delivery of performance improvement projects for service and clinical activities, integrating the quality improvement plan into all departments and facilitating HEDIS, CAHPS and NCQA accreditation activities. Implements and supports the overall implementation of quality programs that meet or exceed applicable State, Federal and NCQA standards.

Principal Accountabilities:

  1. Executes on organizational efforts in ongoing quality improvement processes to ensure compliance with State, Federal, regulatory and accrediting body’s standard requirements.

  2. Responsible for completion and analysis of annual HEDIS results and works with all areas to integrate results into departmental goals.

  3. Identifies resolves and/or escalates problematic QI areas that may place plan at risk of not achieving annual goals.

  4. Collaborates with Provider Services and Member Services to complete analysis of annual satisfaction surveys and works with all areas to integrate results into departmental goals.

  5. Participates in the development, implementation and maintenance of QI policies and procedures.

  6. Serves as a resource to other departments in completing QI goals.

  7. Works professionally and efficiently with all functional areas in meeting organizational and departmental quality goals.

  8. Participates on QI committees structured to achieve outcomes success and completes committee documentation that is consistent in meeting regulatory and accrediting body requirements.

Education/ Experience:

  • Required Associate’s Degree or equivalent work experience Bachelor’s Degree; Registered Nurse preferred.

  • Required HEDIS experience and HEDIS project management, over-read and abstraction experience.

  • CAHPS, NCQA, Quality Compass and Quality Improvement experience preferred.

  • Required minimum of 3 years Healthcare experience..

  • Excellent organizational, analytical and interpersonal skills.

  • Excellent written and verbal communication skills.

  • Ability to work successfully within all levels of the organization.

  • Ability to design, develop and implement projects to address financial, quality and service improvements.

  • Proficient PC skills in a windows based environment.

EOE Minorities/Females/Protected Veterans/Disabled