Quality Improvement Specialist Job Title Quality Improvement Specialist Duration Open until filled Description Let’s do great things, together! About ModaFounded in Oregon in 1955, Moda is proud to be a company of real people committed to quality. Today, like then, we’re focused on building a better future for healthcare. That starts by offering outstanding coverage to our members, compassionate support to our community and comprehensive benefits to our employees. It keeps going by connecting with neighbors to create healthy spaces and places, together. Moda values diversity and inclusion in our workplace. We aim to demonstrate our commitment to diversity through all our business practices and invite applications from candidates that share our commitment to this diversity. Our diverse experiences and perspectives help us become a stronger organization. Let’s be better together. Position SummaryOur Dental Services department is looking for a Quality Improvement Specialist to join their team. The Quality Improvement Specialist serves as the ODS Community Dental contact to Coordinated Care Organizations (CCO) for quality improvement initiatives. Interacts with internal and external partners to define quality program requirements, develop project work plans, execute project tasks and deliverables, document and report project status, and evaluate the effectiveness of quality programs. This is a full-time WFH position based in Portland, Oregon. Pay Range $63,115.35- $78,912.19 ​​​annually.Actual pay is based on qualifications. Applicants who do not exceed the minimum qualifications will only be eligible for the low end of the pay range. Please fill out an application on our company page, linked below, to be considered for this position. https://j.brt.mv/jb.do?reqGK=27747228&refresh=trueBenefits: + Medical, Dental, Vision, Pharmacy, Life, & Disability + 401K- Matching + FSA + Employee Assistance Program + PTO and Company Paid Holidays Required Skills, Experience & Education: + College degree or equivalent work experience in the healthcare industry preferred. + 3 – 5 years’ experience in healthcare insurance industry. + In depth knowledge of operations of CCO dental contracts or dental Medicaid. + Experience in project plan development using project management software. + Knowledge and experience with Oregon Administrative Rules to ensure compliance with contractual requirements. + Strong analytical, problem solving, decision making, organizational, and detail orientation skills. + Ability to work well under pressure, including frequent interruptions and shifting levels of priority. + Strong project related software skills including Microsoft office suite, including Excel and VISIO. + Strong interpersonal and communication skills (both oral and written) with a customer service emphasis. + Ability to be self-sufficient, innovative, work independently and as a team in a fast paced, multi-faceted project. Primary Functions: + Ensure compliance with applicable Oregon Health Authority and CCO-contracted deliverables and quality improvement standards and initiatives. + Supports and contributes to the work of thethe Dental Quality Improvement Committee. + Active member of the dental metrics committee. + Represent ODS Community Dental at CCO quality meetings and ensure the appropriate follow-up to meeting assignments. + Document and report quality and performance initiatives developed by CCOs to appropriate internal stakeholders. + Work with other Moda departments to develop and vet program materials for CCO quality incentives and performance programs established by the CCOs. + Perform quality assurance validations of project deliverables to ensure they meet the overall CCO standards and needs. + Coordinate benefit changes, including rates changes, developing literature, and coordinating new identification cards with the business implementation unit. + Oversee the collection and analysis of data and prepare pertinent documentation and reporting for quality improvement committees, and CCO quality and operations meetings. + Collect and analyze data reporting for various quality improvement initiatives including language access, access to care, etc. + Prepare for audits and reviews by external review organizations for OHA and CCOs. + Develop and update quality improvement policies and procedures including UPMs. + Seek out and participate in professional growth and development activities. + Performs additional duties as assigned Working Conditions & Contact with Others + Remote office environment with extensive close PC and keyboard work, constant sitting, and phone work. Must be able to navigate multiple screens. Occasionally work in excess of standard work week to meet business need. Travel to off-site meetings and to office as needed. + Internally with all levels of staff and management. Externally with Oregon Health Authority and other regulators, Coordinated Care Organizations, DCO Members, Dental Providers, vendors, contractors, consultants. Together, we can be more. We can be better. ​​​​​​Moda Health seeks to allow equal employment opportunities for all qualified persons without regard to race, religion, color, age, sex, sexual orientation, national origin, marital status, disability, veteran status or any other status protected by law. This is applicable to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absences, compensation, and training. For more information regarding accommodations please direct your questions to Kristy Nehler and Daniel McGinnis via our humanresources@modahealth.com email.