Job Description

Job Summary

We are searching for a Quality Improvement Specialist -- someone who works well in a fast-paced setting. In this position, you will facilitate process improvement. This includes leading process improvement using QI methodology, coordinating quality improvement committees and advisory committees, completing regulatory reporting requirements, NCQA accreditation experience and leading provider site process improvement. This role will also serve other operational duties to meet the QI needs of the Texas Children's Health.

* Drive ongoing NCQA accreditation activities for health plan

* Experience as a Registered Nurse or LVN highly preferred

* LEAN, Six Sigma, or CPHQ certification highly preferred

* NCQA or health plan accreditation experience preferred

Responsibilities

* Lead process improvement to meet assigned objectives defined by the Quality Improvement Program

* Serve as subject matter expert on all technical specifications for HEDIS measures

* Lead process improvement at provider sites to support provider's performance on high impact quality measures and adherence to clinical practice guidelines

* Lead provider audit activities to advise corrective action in response to complaints or concerns regarding a provider

* Complete regulatory reporting requirements related to oversight of MCO Quality performance

* Drive ongoing NCQA accreditation activities for health plan

* May lead discussions with accreditation consultants

* Conducts medical record reviews and abstracts needed information for annual HEDIS regulatory requirement

* Works with provider office staff to obtain needed member medical records

* Completes other duties as assigned

Qualifications

Being fully vaccinated against COVID-19, including any booster dose(s) of the COVID-19 vaccine recommended by the Centers for Disease Control when eligible, is required for all employees at Texas Children's, unless approved for a medical or religious exemption

* Bachelor's degree required

* 1 year project management or process/quality improvement experience required (2 years' experience preferred)

* 1 year health plan, Medicaid, or health care related experience preferred

Company Profile

Texas Children's Hospital

Since 1954, Texas Children's has been leading the charge in patient care, education, and research to accelerate health care for children and women around the world. When you love what you do, it truly shows in the smiles of our patient families, employees and our numerous accolades such as being consistently ranked as the best children's hospital in Texas, and among the top in the nation by U.S.News & World Report as well as recognition from Houston Business Journal as one of this city's Best Places to Work for ten consecutive years.

Texas Children's comprehensive health care network includes our primary hospital in the Texas Medical Center with expertise in over 40 pediatric subspecialties; the Jan and Dan Duncan Neurological Research Institute (NRI); the Feigin Center for pediatric research; Texas Children's Pavilion for Women, a comprehensive obstetrics/gynecology facility focusing on high-risk births; Texas Children's Hospital West Campus, a community hospital in suburban West Houston; and Texas Children's Hospital The Woodlands, the first hospital devoted to children's care for communities north of Houston. We have also created the nation's first HMO for children, established the largest pediatric primary care network in the country and a global health program that is channeling care to children and women all over the world. Texas Children's Hospital is also academically affiliated with Baylor College of Medicine, one of the largest, most diverse, and successful pediatric programs in the nation.

To join our community of 14,000 dedicated team members, visit texaschildrenspeople.org for career opportunities. You can also learn more about our amazing culture at infinitepassion.org. At Texas Children's Hospital, diversity, equity, and inclusion are at the core of our values and mission for all of our patients and families that we serve. We are committed to providing a diverse and inclusive work environment for all faculty, staff, and learners throughout our organization. We believe that each member of our one amazing team provides enrichment that allows us to create a lasting legacy for future employees of this great organization.

Texas Children's is proud to be an equal opportunity employer. All applicants and employees are considered and evaluated for positions at Texas Children's without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, gender identity, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.

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