Quality of Care Specialist Job at State of Colorado Job Opportunities
Department Information
STATE OF COLORADO RESIDENCY REQUIRED
NOTE: This announcement may be used to fill multiple openings.
The Department of Health Care Policy & Financing (HCPF) oversees and operates Health First Colorado (Colorado's Medicaid Program), Child Health Plan Plus (CHP+), and other state public health programs for qualified Coloradans. Our mission is to improve health care equity, access and outcomes for the people we serve while saving Coloradans money on health care and driving value for Colorado.
We are committed to increasing the diversity of our staff and providing culturally responsive programs and services. Therefore, we encourage responses from people of diverse backgrounds and abilities.
As part of the State of Colorado, HCPF offers a competitive benefits package:
-
PERA retirement benefits including PERA Defined Benefit Plan, PERA Defined Contribution Plan, plus 401K and 457 plans
-
Medical, Dental, and Vision insurance coverage
-
Automatic Short-Term and Optional Long-Term Disability Coverage
-
Life and AD&D Insurance
-
Flexible Spending Accounts (FSAs)
-
Family Medical Leave Act (FMLA) job protection and State of Colorado Paid Family Medical Leave (PFML)
-
11 Paid Holidays Annually and Accrued Annual and Sick Leave
-
Accrued Sick Leave for State of Colorado Temporary Employees
-
Flexplace and Flextime work arrangements
-
Variety of discounts on services and products available through the State of Colorado's Work-Life Employment Discount Program
-
Free RTD EcoPass to all eligible State Employees
-
Credit Union of Colorado Membership Eligibility
- Some positions may qualify for the Public Service Loan Forgiveness Program. For more information, go to https://www.colorado.gov/pacific/dhr/student-loan-forgiveness-programs. https://dhr.colorado.gov/dhr-resources/student-loan-forgiveness-programs
The ongoing COVID-19 pandemic has impacted how and where we do our work. During this pandemic, we are onboarding new employees using a hybrid approach. The Department supports flexible work arrangements. Depending on the business need and description of the position, we have options that range from fully remote, hybrid, to full-time in the office. Specific discussions about the schedule will be discussed during the offer stage.
Cost Control & Quality Improvement Office
Solutions to achieve the objectives of the Office may present in the form of utilization review, population management, case or disease management, value based and related alternate payment methodologies, digital tools that facilitate efficient provider selection or member insights, analysis supporting interpretations, insights, and solutions and more.
The Office leads collaborative efforts to drive down healthcare costs and prices paid by consumers, employers and other payers, across the state.
The Office works to collaborate with other areas of the Department such as the Accountable Care Collaborative staff to secure insights into cost trend drivers and evolving utilization patterns. The Office crafts cost management strategy, selects cost management vendor partners, researches health care industry innovations, oversees cost management program effectiveness and return on investment within Medicaid, CHP+ and other Health Safety Net programs. This position will serve as the Quality of Care (QOC) Specialist in the Quality & Health Improvement (QHI) section to address specific reported concerns surrounding quality of care delivery and grievance tracking and reporting for Medicaid members. The QOC Specialist will be responsible for routine monitoring of Quality of Care Concerns and Quality of Care Grievances (QOCGs). This position will work with and respond to requests for audit information from Health Services Advisory Group (HSAG). As authorized by the Section Manager and CCQI Director, the QHI Section and the QOC Specialist will assist other sections and units of the Department of Health Care Policy & Financing Department.
Description of Job
The Cost Control & Quality Improvement (CCQI) Office welcomes your interest in the Quality of Care Specialist position. The position serves as the staff authority and key advisor to senior management within the Quality Section of CCQI. As the quality of care Staff Authority, this position directs, implements, and manages the following:
The position provides advice regarding Department guidelines which have a direct impact on Quality of Care policies, procedures, desktop protocols, process documents and resolution/outcome documentation for internal divisions and outside agencies.
Responsibilities include the following:
- Quality of Care Grievances (QOCGs)
- Quality performance measure management analysis and reporting
- Quality of Care inbox
- Leading the Quality of Care Concerns and Quality of Care Grievances Review Committee (QCRC)
The position provides advice regarding Department guidelines which have a direct impact on Quality of Care policies, procedures, desktop protocols, process documents and resolution/outcome documentation for internal divisions and outside agencies.
Responsibilities include the following:
Identifies and determines the best quality strategy for tracking and monitoring Quality of Care Grievances (QOCGs). Partners with the Office of Community Living (OCL), Health Policy Office (HPO) and third-party vendors, to direct, plan, develop and implement annual Health Services Advisory Group (HSAG) audit and compliance monitoring program requirements. Identifies and creates project work plans and timelines for internal and external audits and prepares draft reports to identify trends and areas of opportunity.- Supports the enhancement of evidence-based strategies and services to improve the quality of care, mitigating the impacts of reported concerns, grievances and complaints.
- Ensures the Department and other state agencies are in compliance with the requirements set forth by internal and external audit requirements including the audit recommendations from Health Services Advisory Group (HSAG).
- Determines, analyzes, and implements quality improvement performance metrics to drive performance-based outcomes for Colorado's Health First Colorado Medicaid and CHP+ program.
- Identifies and selects defined data sources to develop and manage a methodology for assigning quality ratings based on performance measure data and survey results.
- Identifies and determines the best quality strategy for the Quality of Care Compliance monitoring program planning, execution, and identification of corrective action plans.
- Directs, plans, develops, and implements annual Health Services Advisory Group (HSAG) audit and compliance monitoring program with the Department's Medicaid, CHP+ and other Health Safety Net programs.
- Creates project work plans and timelines for annual review and areas of opportunity.
- Manages the Quality of Care inbox by responding to concerns, grievances and complaints in a timely manner. Each inbox concern, grievance and complaint will be evaluated while maintaining a focus on clinical care issues and determining when the issue should be escalated appropriately and reviewed by the QCRC.
- Compliance and auditing program issues, reporting, discrepancies, and other activities that need further review.
- Provides guidance with other special Quality of Care projects as assigned.
- Expert on Quality of Care Performance Measures; informs statewide programs of program goals.
- Influences programs, policy, standards and implementation decisions related to Quality of Care Performance across the Department and with internal and external state agencies including Regional Accountable Entities (RAEs), Medicaid MCOs, CHP+ MCOs and Dental PAHP.
Minimum Qualifications, Substitutions, Conditions of Employment & Appeal Rights
Education and Experience:
Bachelor's degree from an accredited institution in a field of study related to the work assignment.
AND
Three years of professional experience in an occupational field related to the work assigned to the position including:
Experience in healthcare program development and implementation- Experience in healthcare/clinical quality performance improvement and regulatory compliance
Substitutions
Additional appropriate experience will substitute for the degree requirement on a year-for-year basis. Appropriate experience will substitute for the degree requirement on a year-for-year basis.
Preferred Qualifications
Working knowledge of State and Federal Medicaid rules and regulations.- Experience with federal compliance including managed care requirements.
- Ability to set and prioritize workload, develop a work plan with tasks, time frames, milestones, resources, and dependencies.
- Strong communication skills, verbal and written.
- Ability to be self-motivated and self-directed, while possessing the ability to work in a team environment.
- Current, valid licensure as a Registered Nurse from the Colorado Board of
Nursing or any state participating in the Enhanced Nurse Licensure Compact (eNLC). - Relevant State of Colorado experience.
DEFINITION OF PROFESSIONAL EXPERIENCE:
Work that involves exercising discretion, analytical skill, judgment, and personal accountability, and responsibility for creating, developing, integrating, applying, and sharing an organized body of knowledge that characteristically is uniquely acquired through an intense education or training regimen at a recognized college or university; equivalent to the curriculum requirements for a bachelor's or higher degree with major study in or pertinent to the specialized field; and continuously studied to explore, extend, and use additional discoveries, interpretations, and application and to improve data, materials, equipment, applications and methods.
Conditions of Employment
-
All positions at HCPF are security sensitive positions and require that the individuals undergo a criminal record background check as a condition of employment.
-
Employees who have been disciplinary terminated, resigned in lieu of disciplinary termination, or negotiated their termination from the State of Colorado must disclose this information on the application.
APPEAL RIGHTS:
If you receive notice that you have been eliminated from consideration for this position, you may file an appeal with the State Personnel Board or request a review by the State Personnel Director.
An appeal or review must be submitted on the official appeal form, signed by you or your representative. This form must be delivered to the State Personnel Board by email (dpa_state.personnelboard@state.co.us), postmarked in US Mail or hand delivered (1525 Sherman Street, 4th Floor, Denver CO 80203), or faxed (303.866.5038) within ten (10) calendar days from your receipt of notice or acknowledgement of the department’s action.
For more information about the appeals process, the official appeal form, and how to deliver it to the State Personnel Board; go to spb.colorado.gov; contact the State Personnel Board for assistance at (303) 866-3300; or refer to 4 Colorado Code of Regulations (CCR) 801-1, State Personnel Board Rules and Personnel Director's Administrative Procedures, Chapter 8, Resolution of Appeals and Disputes, at spb.colorado.gov under Rules.
Supplemental Information
How to Apply
(PLEASE READ CAREFULLY)
Please note that ONLY your State of Colorado job application will be reviewed during the initial screening; if you submit a resume and cover letter, they will be reviewed in later stages of the selection process. Therefore, it is paramount that you clearly describe all your relevant experience on the application itself. Applications left blank or marked "SEE RESUME" will not be considered.
Your application will be reviewed against the minimum qualifications for the position. If your application demonstrates that you meet the minimum qualifications, you will be invited to the comparative analysis process, which is described below.
Comparative Analysis Process
The comparative analysis process will consist primarily of a review of applications against the minimum and preferred qualifications of this position. Applications will be reviewed in comparison to all others in the applicant pool in order to identify a top group of candidates who may be invited for a final interview. Depending on the size of the applicant pool, additional selection processes may be utilized to identify a top group of candidates. Applicants will be notified of their status via email.
Failure to submit properly completed documents by the closing date will result in your application being rejected.
ADAAA Accommodations: The State of Colorado believes that equity, diversity, and inclusion drive our success, and we encourage candidates from all identities, backgrounds, and abilities to apply. The State of Colorado is an equal opportunity employer committed to building inclusive, innovative work environments with employees who reflect our communities and enthusiastically serve them. Therefore, in all aspects of the employment process, we provide employment opportunities to all qualified applicants without regard to race, color, religion, sex, disability, age, sexual orientation, gender identity or expression, pregnancy, medical condition related to pregnancy, creed, ancestry, national origin, marital status, genetic information, or military status (with preference given to military veterans), or any other protected status in accordance with applicable law.
The Department of Health Care Policy & Financing is committed to the full inclusion of all qualified individuals. As part of this commitment, our agency will assist individuals who have a disability with any reasonable accommodation requests related to employment, including completing the application process, interviewing, completing any pre-employment testing, participating in the employee selection process, and/or to perform essential job functions where the requested accommodation does not impose an undue hardship. If you have a disability and require reasonable accommodation to ensure you have a positive experience applying or interviewing for this position, please direct your inquiries to our ADAAA Coordinator, Virginia Miller, at virginia.miller@state.co.us.
The Department of Health Care Policy & Financing does not offer sponsored visas for employment purposes.
~THE STATE OF COLORADO IS AN EQUAL OPPORTUNITY EMPLOYER~
Technical Assistance
If you experience difficulty in uploading or attaching documents to your online application, or for any other technical difficulties, call NEOGOV technical support at 855-524-5627 anytime between 6:00 a.m.-6:00 p.m. (Pacific Time).
Please Note :
bankofmontserrat.ms is the go-to platform for job seekers looking for the best job postings from around the web. With a focus on quality, the platform guarantees that all job postings are from reliable sources and are up-to-date. It also offers a variety of tools to help users find the perfect job for them, such as searching by location and filtering by industry. Furthermore, bankofmontserrat.ms provides helpful resources like resume tips and career advice to give job seekers an edge in their search. With its commitment to quality and user-friendliness, Site.com is the ideal place to find your next job.