Senior Quality Improvement Professional (HEDIS)

The Senior Quality Improvement Professional uses data to develop and lead quality improvement projects and monitors performance metrics for KY Medicaid.

Updates, manages, and complies the QI requirement documentation (QI Program Description, QI Work Plans, and QI Evaluation)

Develops, implements, and evaluates activities of state required Performance Improvement Projects (PIPs) in collaboration with internal and external partners

Facilitates/participates in quality committees and quality improvement related meetings and discussion with internal and external partners

Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas.

Develops strategy to improve Performance Measures as identified by the state.

Assesses drivers for low performing measures

Develops interventions to improve Performance Measure rates

Assesses need for member and provider collateral information (i.e. HEDIS tip sheets, other support pieces – i.e. provider web based training) and develops collateral documentation needed

Works with analyst to develop Performance Measure view for performance measures and identify those practices who potentially need assistance with performance measures (i.e. HEDIS measure analysis)

Leads and participates in QI activities designed to improve performance measures

Collaborates with member and provider facing teams to drive QI activities

Subject Matter Expert for all member and provider quality and performance measures content for documents like the Enrollee Newsletter, Provider Manual, and quality documents

Strong relationship building skills