PREFER QUALIFICATIONS

• Call Center Experience

Qualifications:

• Bachelors degree in related field. 6 years of additional experience can be substituted in lieu of degree.
• 4 years of healthcare, managed care industry experience required

Responsibilities:

• Supervise the overall direction, coordination, implementation, and completion of clinical and quality programs aligned with the PHS Scorecard and organizational strategy.
• Direct and delegate daily operations for staff, including assigning caseloads and supporting program planning.
• Lead staffing activities including interviewing, hiring, coaching, providing performance feedback, and mentoring.
• Develop and implement Benefit, Pharmacy, and Provider Quality solutions to issues identified during member-facing activities.
• Collaborate with leadership to establish Quality and Population Health program expectations.
• Partner with Analytics Operations (AO) and data teams to design Quality program activities based on insights from Medicare Stars, HEDIS, and NCQA requirements.

• Collaborate with training teams to develop and deliver Quality and Customer Service educational opportunities for staff.Oversee Quality program activities aimed at improving HEDIS, Medicare Stars, and Risk Adjustment performance, consistent with PHS Scorecard expectations.

• Benefits:
  All benefits-eligible Presbyterian employees receive a comprehensive benefits package that includes medical, dental, vision, short-term and long-term disability, group term life insurance and other optional voluntary benefits.

• Supervise the overall direction, coordination, implementation, and completion of clinical and quality programs aligned with the PHS Scorecard and organizational strategy.
• Direct and delegate daily operations for staff, including assigning caseloads and supporting program planning.
• Lead staffing activities including interviewing, hiring, coaching, providing performance feedback, and mentoring.
• Develop and implement Benefit, Pharmacy, and Provider Quality solutions to issues identified during member-facing activities.
• Collaborate with leadership to establish Quality and Population Health program expectations.
• Partner with Analytics Operations (AO) and data teams to design Quality program activities based on insights from Medicare Stars, HEDIS, and NCQA requirements.
• Collaborate with training teams to develop and deliver Quality and Customer Service educational opportunities for staff.Oversee Quality program activities aimed at improving HEDIS, Medicare Stars, and Risk Adjustment performance, consistent with PHS Scorecard expectations