Highmark Health

Medicare Advantage Quality Consultant - (Northeastern PA)

Highmark Health

Remote
Full-TimeDepends on ExperienceSenior LevelMasters
Job Description

Welcome to Highmark Health, where we are committed to providing high-quality healthcare services to our valued Medicare Advantage members in Northeastern Pennsylvania. We are seeking a dedicated and experienced Quality Consultant to join our team and help ensure that our members receive the best possible care. As a Medicare Advantage Quality Consultant, you will play a crucial role in maintaining and improving the quality of our healthcare services, ultimately making a positive impact on the lives of our members. If you have a passion for improving healthcare outcomes and possess the necessary qualifications, we invite you to apply for this exciting opportunity.

  1. Collaborate with healthcare providers to monitor and evaluate the quality of care provided to Medicare Advantage members in Northeastern Pennsylvania.
  2. Conduct audits and assessments to identify areas for improvement and develop strategies to enhance the quality of healthcare services.
  3. Analyze data and metrics to track and report on the effectiveness of quality improvement initiatives.
  4. Stay updated on industry trends and best practices in quality improvement to continuously improve our services.
  5. Develop and implement training programs for healthcare providers to ensure compliance with quality standards and regulations.
  6. Communicate with internal teams and external stakeholders to share insights and recommendations for improving healthcare outcomes.
  7. Participate in quality improvement meetings and committees to provide input and contribute to decision-making processes.
  8. Collaborate with cross-functional teams to develop and implement quality improvement projects and initiatives.
  9. Monitor and ensure compliance with regulatory requirements and accreditation standards.
  10. Conduct periodic reviews and audits to assess the effectiveness of quality improvement efforts.
  11. Provide support and guidance to healthcare providers in implementing evidence-based practices and protocols.
  12. Identify and address any gaps or deficiencies in the delivery of healthcare services to ensure high-quality care for Medicare Advantage members.
  13. Develop and maintain strong relationships with healthcare providers and other stakeholders to promote a culture of quality improvement.
  14. Serve as a subject matter expert on quality improvement initiatives and provide guidance to team members and other departments as needed.
  15. Continuously evaluate and improve processes and procedures related to quality improvement to ensure efficiency and effectiveness.
Where is this job?
This job opening is listed as 100% remote
Job Qualifications
  • Bachelor's Degree In Healthcare Administration, Public Health, Or A Related Field.

  • Minimum Of 3-5 Years Of Experience Working With Medicare Advantage Plans, Preferably In The Northeastern Pa Region.

  • In-Depth Knowledge Of Cms Regulations And Guidelines For Medicare Advantage Plans.

  • Strong Analytical And Problem-Solving Skills, With The Ability To Interpret And Present Data Effectively.

  • Excellent Communication And Interpersonal Skills, With The Ability To Collaborate With Various Stakeholders And Build Relationships With Providers And Members.

Required Skills
  • Quality Assurance

  • Data Analysis

  • Compliance Management

  • Clinical documentation

  • Audit management

  • Utilization management

  • Performance Improvement

  • Risk Adjustment

  • Healthcare Regulations

  • Quality Reporting

  • H

  • Provider Education

Soft Skills
  • Communication

  • Conflict Resolution

  • Leadership

  • Time management

  • Interpersonal Skills

  • creativity

  • Critical thinking

  • Teamwork

  • Adaptability

  • Problem-Solving

Compensation

According to JobzMall, the average salary range for a Medicare Advantage Quality Consultant - (Northeastern PA) is $75,000 - $85,000 per year. However, this can vary depending on factors such as the specific company, location, and level of experience. Some companies may offer bonuses or additional benefits such as health insurance and retirement plans.

Additional Information
Highmark Health is an Equal Opportunity Employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. We do not discriminate based upon race, religion, color, national origin, sex, sexual orientation, gender identity, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics.
Required LanguagesEnglish
Job PostedDecember 17th, 2024
Apply BeforeJuly 20th, 2025
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About Highmark Health

Highmark Inc. is among the largest health insurers in the United States and the fourth-largest Blue Cross and Blue Shield-affiliated company. Highmark and its diversified businesses and affiliates operate health insurance plans in Pennsylvania, Delaware and West Virginia that serve 5.2 million members. Its diversified health businesses serve group customer and individual health needs across the United States through dental insurance, vision care and other related health businesses. Highmark is an independent licensee of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield companies.

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