Experience:
1-3 years of experience
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Employment Type:
Full time
Posted:
10/4/2016
Job Category:
Health Care Provider
Quality Improvement Specialist II Woodland Hills, CA (#27545)
Health Net, Inc. | Woodland Hills, California
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Job Description

Competencies

A. Gets the Basics Right

B. Makes Us Better Every Day

C. Builds Effective and Trusting Relationships

D. Looks Ahead, Learns and Adapts

E. Acts on Facts, Not Assumptions

G. Creates Value for Stakeholders

F. Shows Passion for the Business

Job Summary

The Quality Improvement Specialist II is responsible for coordinating regulatory, accreditation, clinical quality and/or service improvement programs. Implements programs in compliance with department, accreditation and regulatory requirements/ standards and monitors ongoing program performance.

 

Essential Duties & Responsibilities

  • Implements clinical, service and/or business supported initiatives that impact the quality or effectiveness of health care delivery and/or health care services provided to members.
  • Works collaboratively with other departments to conduct needs assessments and implement new systems. May act as a subject matter expert.
  • Evaluates initiatives on operations or health care delivery and effectively identifies and communicates change process and impact of these initiatives.
  • Participates in work group or meetings with industry groups, community coalitions, contracted providers or provider groups, vendors, regulators, accrediting bodies or other entities to assure programs goals, accreditation and regulatory requirements are met.
  • Assists in identify areas of improvement for the department and participates in development of clinical and non-clinical performance improvement projects.
  • Provides feedback on policies and procedures.
  • Develops, prepares reports, data or other materials for management. Responsible for data management and integrity.
  • Performs other duties as assigned.

 

Education

  • Bachelor's degree with equivalent experience or Bachelor's degree with Registered Nurse License

 

Certification/Licensure Required

  • Valid state clinical license preferred

 

Government Clearance & US Citizenship Requirement

N/A

Experience Required

  • Minimum two years clinical or health care experience
  • Minimum three years managed care experience
  • Experience in compliance, accreditation, service or quality improvement preferred
  • Complex project management experience preferred
  • OR Any combination of academic education, professional training or work experience, which demonstrates the ability to perform the duties of the position

 

Knowledge, Skills & Abilities

  • Knowledge of accreditation, federal and state regulations/requirements preferred
  • Knowledge of research methodology and design preferred
  • 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 preferred
  • 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

 

Working Conditions

  • The following section describes the general physical requirements for this position. Please note that constant refers to more than 81% of time; significant refers to 40-80%; and moderate refers to 20-40% of the time.
  • Operates personal computers, printers, facsimile, telephones, copy machines and other commonly used office accessories/equipment.
  • Exposed to confidential information and expected to maintain confidentiality at all times; must adhere to HIPAA rules and regulations.
  • May be required to work outside of normally scheduled hours as mandated by the client, project and/or workload (e.g. evenings, weekends, and/or holidays).
  • May be required to maintain established work pace, meet deadlines; may have last minute urgent requests.
  • Physical activity may include: twisting, reaching, kneeling, bending, stooping, squatting, crawling, grasping, grabbing, pushing, pulling, repetitive motion, climbing, etc.
  • Required to have visual acuity to determine the accuracy, neatness, and thoroughness of the work assigned.
  • Required to have hearing ability to receive detailed information through oral communication.
  • Required to have speaking ability to express or exchange ideas.
  • Constant concentration may be required on various subjects by listening, reading and thinking clearly.
  • Interaction with others may be required. May need to listen, think, and speak in order to interact with others. Business interactions and behavior between coworkers and/or external customers are required. This may require face-to-face or telephone interactions.
  • Thinking at work may include listening, learning, analyzing, evaluating, and the ability to interpret what is seen and/or heard, or to link information from one issue to the next.
  • Significant computer usage including typing and/or eye strain.
  • Significant repetitive arm, wrist, hand and finger motions -- making repetitive movements (e.g. key boarding, filing, data entry).
  • Significant phone usage; headsets may be required.
  • Moderate lifting may be required. May need to lift, carry and/or move equipment/supplies weighing up to 10 pounds, always using safe lifting techniques.
  • Moderate amount of time spent working in a loud office environment with frequent interruptions/distractions.
  • Constant sedentary work (desk bound or seated).
  • Constant reading is required via computer screen and/or bound printed materials.

Disclaimer

DISCLAIMER: The above statements are intended to describe the general nature and level of work being performed by individuals assigned to this job. They are not intended to be construed as an exhaustive list of responsibilities, duties and skills required of personnel so classified.

About Health Net, Inc.

Health Net, Inc. (Health Net) is an integrated managed care organization that delivers managed healthcare services through health plans and government-sponsored, managed-care plans. The Company operates and conducts its businesses through its subsidiaries. Health Net's health plans and government contracts subsidiaries provide health benefits through its health maintenance organizations (HMOs), insured preferred provider organizations (PPOs) and point-of-service (POS) plans to approximately 6.7 million individuals across the country through group, individual, Medicare, (including the Medicare prescription drug benefit commonly referred to as Part D), Medicaid, TRICARE and Veterans Affairs programs. The Company operates within two segments: Health Plan Services and Government Contracts. (Source: 10-K)

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