Program Manager, QI & Education Campaign

Administrative Carmel, Indiana Fort Worth, Texas


Description

American Specialty Health Incorporated is seeking a QI & Education Campaigns Program Manager to join our Practitioner Contracting Administration (PCA) department. This position is to practitioner program oversight for quality improvement (QI) initiatives and practitioner education campaigns and provide an unbiased view of customers’ experiences while interacting with provider services.

Responsibilities

  • Provides program oversight for quality improvement (QI) initiatives.
  • Establishes an action plan for “Secret/Mystery Shopper” QI initiative for monitoring access and availability to care in accordance with established procedures.
  • Place phone calls to secret shop a large sample size of health plan providers nationwide to evaluate appointment availability.
  • Collect Pass/Fail conditions during the call to collect data for the survey.
  • Captures and reports results of “Secret Shopper” QI initiative for annual summary. Provides status updates to Manager as needed.
  • Establishes an action plan for other QI initiatives as assigned.
  • Captures and reports results of other assigned QI initiatives. Provides status updates to Manager as needed.
  • Communicates findings and outcomes of QI initiatives to management and department as directed.
  • Support health plan monitoring and analysis.
  • Identifies and obtains various practitioner source listings (i.e. via client match reports, PROMIS, etc) to support recruitment efforts.
  • Assists with quality initiatives to create efficiencies in the integration of provider data, member data, and utilization/claims data for campaign management.
  • Maintains and improves report quality by performing audit reporting to ensure guidelines and specifications are met.
  • Prepares and presents feedback on deficiencies identified in accuracy, timeliness, and/or quality to Manager, Practitioner Contracting Support.
  • Researches quality improvement opportunities to streamline the campaign management data process.
  • Support quality initiative implementation by contributing information and analysis to strategic plans and system reviews.
  • Validates data quality processes by establishing product specifications and writing quality assurance procedures.
  • Provides program oversight for practitioner education campaigns.
  • Establishes action plans including the identification of all required participants, action steps and responsible parties with associated deliverable dates to ensure high quality and efficient coordination for each campaign.
  • Interfaces internally and externally with key functional areas to identify campaign sites.
  • Conducts regular campaign update sessions with leadership team to provide status of campaign summaries and timelines. Communicates and presents status to other internal staff as directed.
  • Assists in the update and maintenance of provider target lists for invitations to new or ongoing educational campaigns. Verifies targeted practitioner/health plan client lists prior to each campaign and manages process to ensure invitations are sent and RSVPs are received.
  • Provides important feedback for future educational/practitioner communication initiatives.
  • Receives and organizes surveys/feedback from participants and reports to management to support provider retention initiatives. Identifies opportunities to improve and enhance campaigns and provides feedback for future educational/practitioner communication initiatives.
  • Coordinates health plan client requests for representations at health fairs as needed.
  • Supports Practitioner Contract Services in their interaction with practitioners regarding practitioner education information from webinars/seminars.
  • Provides program support for practitioner recruitment campaigns.
  • Facilitates the annual review/ordering practitioner licensure lists from state board or vendors in conjunction with team members.
  • Facilitates the cleaning, organizing, and loading of licensure lists to the recruitment system.
  • Conducts audits of cleaned licensure lists for quality and accuracy.
  • Prepares and presents feedback on deficiencies identified in accuracy, timeliness, and/or quality to Manager, Practitioner Contracting Support.

Qualifications

  • Associate’s degree or equivalent experience preferred. If equivalent experience, high school diploma required.
  • Minimum four years’ experience with project coordination and/or supporting quality improvement initiatives. Experience with event planning helpful, including experience with negotiating rates and contracts.
  • Experience in specialty health care environment strongly preferred.
  • Experience with Mystery Shopping survey of high- volume outbound calling preferred.
  • Experience with collaborating analytics in every stage of the project from the initial research question formulation to data collection, analysis, and visualization.
  • Proficient in MS Office, with advanced Word and Excel experience as well as ability to create and edit presentations using Power Point.
  • Strong project management skills, with the ability to identify timelines and action plans and see projects through to completion.
  • Excellent verbal communication skills to effectively communication via telephone.

Core Competencies

  • Demonstrated ability to interact in a positive, respectful manner and establish and maintain cooperative working relationships.
  • Ability to display excellent customer service to meet the needs and expectations of both internal and external customers.
  • Excellent listening and interpersonal communication skills to identify critical core competencies based on success factors and organizational environment.
  • Ability to effectively organize, prioritize, multi-task and manage time.
  • Demonstrated accuracy and productivity in a changing environment with constant interruptions.
  • Demonstrated ability to analyze information, problems, issues, situations and procedures to develop effective solutions.
  • Ability to exercise strict confidentiality in all matters.

Mobility

Primarily sedentary, able to sit for long periods of time. 

Physical Requirements

Ability to speak, see and hear other personnel and/or objects. Ability to communicate both in verbal and written form. Ability to travel within the facility. Capable of using a telephone and computer keyboard. Ability to lift up to 10 lbs.

Environmental Conditions

Usual office setting.

AmericanSpecialty Health is an Equal Opportunity/Affirmative Action Employer. 

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex including sexual orientation and gender identity, national origin, disability, protected Veteran Status, or any other characteristic protected by applicable federal, state, or local law.

Please view Equal Employment Opportunity Posters provided by OFCCP here

If you are a qualified individual with a disability or a disabled veteran, you have the right to request an accommodation if you are unable or limited in your ability to use or access our career center as a result of your disability. To request an accommodation, contact our Human Resources Department at (800) 848-3555 x6702. 

ASH will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the Company’s legal duty to furnish information.