Quality Improvement Specialist (Equity & Practice Transformation Program)
Quality Improvement Specialist (Equity & Practice Transformation Program)
CalOptima
CalOptima Health is seeking a highly motivated an experienced Quality Improvement Specialist (Equity & Practice Transformation Program) to join our team. The Quality Improvement Specialist for the Equity and Practice Transformation Program in Quality Analytics will be responsible for providing education and support to CalOptima Health provider groups to achieve improved performance for clinical quality metrics established by the Health Effectiveness Data and Information Set (HEDIS), Medi-Cal Managed Care Accountability Set (MCAS), National Committee for Quality Assurance (NCQA), Centers for Medicare & Medicaid Services (CMS) and other entities. The incumbent will assist department leadership in implementing and evaluating projects aimed at achieving the goals of the Department of Health Care Services' (DHCS) Equity and Practice Transformation Program, such as improving quality of care, advancing health equity and practice transformation for primary care practices.
Position Information:
• Department: Quality Analytics
• Salary Grade: 309 - $68,015 - $108,824 ($32.70 - $52.3192)
• Work Arrangement: Partial Telework
**This position is eligible for telework in California.**
Duties & Responsibilities:
• 85% - Equity and Practice Transformation Program Support
• Participates in a mission driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.
• Provides ongoing support, virtually and onsite as needed, to health network provider groups.
• Participates in meetings with health network provider groups to review performance for quality measures and CalOptima Health's Pay for Value (P4V) programs.
• Assists health network providers with understanding and implementing best practices to improve performance.
• Communicates quality measure changes to health network providers, helping providers and office staff understand which metrics are being tracked across quality improvement programs, and how their practices influence performance for those metrics.
• Promotes evidence-based clinical guidelines in collaboration with CalOptima Health Medical Directors.
• Promotes and drives participation in health network quality collaborative opportunities such as CalOptima Health's Standing Orders Program.
• Promotes and drives health network provider participation in direct electronic medical record (EMR) integration and data exchange.
• Acts as the liaison between the health network provider, CalOptima Health Information Technology (IT) team and the integration vendor.
• Collaborates with the HEDIS team to provide education on CalOptima Health tools and resources, such as the provider portal, as well as coding and documentation requirements related to quality care gap closure.
• Participates and presents at Community Clinic monthly meetings, as well as quarterly Health Network Lunch and Learn meetings.
• Assists with preparation of notices of underperformance to health network providers and assists with communicating quality performance reports to health network providers that substantiate underperformance or at-risk performance.
• Works with collaborating participants intra- and interdepartmentally to establish goals, create interventions, implement and evaluate priority projects with input and oversight of medical management.
• Collaborates with cross functional teams to develop and implement rapid cycle improvement projects or Plan-Do-Study-Act (PDSA) projects, performance improvement projects (PIPs) and quality improvement projects (QIPs) as required by the California Department of Healthcare Services (DHCS), Center for Medicare and Medicaid Services (CMS) or for other internal QIPs.
• Develops specific, measurable, achievable, relevant and time-bound (SMART) goals and metrics, project documents, process flows and other items as applicable.
• Assists with the completion of root cause analysis and impact analysis to determine the success of initiatives, projects and pilots to measure quality performance.
• Develops run charts, control charts and other graphical representations of Continuous Quality Improvement (CQI) project metrics as appropriate.
• Collaborates with cross functional teams to develop targeted quality improvement initiatives to improve clinical quality performance measures, including HEDIS, DHCS or CMS metrics, future quality rating system metrics, etc.
• Stays current on DHCS, NCQA and CMS regulation changes that impact quality metrics and performance expectations.
• 10% - Administrative Support
• Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.
• 5% - Other
• Completes other duties and projects as assigned.
Minimum Qualifications:
• Bachelor's degree in health care, health care data informatics or a related field PLUS 2 years of experience in quality metrics analysis and improvement required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying.
• 2 years of experience interacting with primary care provider offices and/or community clinics required.
• 1 year of experience in systems integration, electronic health information solutions or EMR integration or implementation required.
• Valid driver's license and vehicle or other approved means of transportation, an acceptable driving record and current auto insurance will be required for work away from the primary office 30% of the time or more.
Preferred Qualifications:
• 2 years of experience in a managed care health plan.
• Experience in a capitated environment and highly delegated model.
Required Licensure / Certifications:
• n/a
Knowledge & Abilities:
• Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds.
• Work independently and exercise sound judgment.
• Communicate clearly and concisely, both orally and in writing.
• Work a flexible schedule; available to participate in evening and weekend events.
• Organize, be analytical, problem-solve and possess project management skills.
• Work in a fast-paced environment and in an efficient manner.
• Manage multiple projects and identify opportunities for internal and external collaboration.
• Motivate and lead multi-program teams and external committees/coalitions.
• Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.
Physical Requirements (With or Without Accommodations):
• Ability to visually read information from computer screens, forms and other printed materials and information.
• Ability to speak (enunciate) clearly in conversation and general communication.
• Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions.
• Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting.
• Lifting and moving objects, patients and/or equipment 10 to 25 pounds
Work Environment:
If located at the 500, 505 Building or a remote work location:
• Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.
• There are no harmful environmental conditions present for this job.
• The noise level in this work environment is usually moderate.
If located at PACE:
• Work is typically indoors in a clinical setting serving the frail and elderly.
• There may be harmful or hazardous environmental conditions present for this job.
• The noise level in this work environment is usually moderate to loud.
If located in the Community:
• Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.
• Employee will occasionally work outdoors in varied temperatures.
• There may be harmful or hazardous environmental conditions present for this job.
• The noise level in this work environment is usually moderate to loud.
About CalOptima Health:
CalOptima Health is the single largest health plan in Orange County, serving one in four residents. Our motto - "Better. Together." - is at the heart of our mission to serve members with excellence, dignity and respect. We are a public agency made up of compassionate leaders and professionals working together to strengthen our community's health. We are continuing to build a culture that promotes diversity and inclusion within our community where employees have a sense of belonging, and are valued for their ideas, contributions, and their unique individual perspectives they bring. CalOptima Health has been recognized as one of Orange County's best places to work, so we know there is something special about our organization. It is why people choose to work here and why they choose to stay!
About our Benefits & Wellness options:
At CalOptima Health, we know that a healthy and happy workforce is a thriving workforce, which is why we offer a comprehensive benefits package, including participation in the California Public Employees Retirement System (CalPERS), low-cost medical/vision/dental insurance options, and paid time off. To support quality work-life balance, we allow flexible scheduling during core business hours, telework options for some positions, and a wellness program featuring diverse activities. Additionally, CalOptima Health contributes 4% of pensionable earnings to a 401(a) retirement program with no required employee contribution. For those who are interested in additional retirement savings, employees have access to 457(b) retirement plans with pre/post-tax contribution options. For more information, please click on the https://alliantbenefits.cld.bz/25caloptimacabenguide regarding our comprehensive benefits and wellness package.
IMPORTANT APPLICATION INFORMATION AND INSTRUCTIONS
Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. The deadline for the first review of applications is June 5, 2025 at 9:00 PM (PST). Applicants are encouraged to apply early. Applicants that apply after the first review are not guaranteed to be considered for this recruitment. This recruitment may close at any time without notice after the first review date.
The selection process may include, but is not limited to, a skills assessment, phone screen and interview.
The successful candidate will be required to undergo a reference / background check (to include a conviction record) and if applicable also pass a post-offer pre-employment medical examination (which will include a drug screening). Internal CalOptima Health applicants should apply through InfoNet.
Communication regarding your application will be sent to the email address listed on your application. Please check your email, including your SPAM folder, regularly throughout the recruitment process. You can also visit your candidate portal to receive the most up to date status of your application.
CalOptima Health is committed to attracting, hiring, and retaining a diverse staff, where we will honor your unique experiences, identity, and perspectives. Our organization strives to create and maintain a workplace environment that is inclusive, equitable and welcoming so we can truly be Better Together.
CalOptima Health is an equal opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health wants to have qualified employees in every job position. CalOptima Health prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima Health also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics.
If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation at (714) 246-8400 if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability.
To apply, please visit: https://apptrkr.com/6248357
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