GEHA is a leader in health services for federal employees and related customers, serving our chosen markets with low-cost offerings and best-in-class customer care, sustained by a nimble and efficient organization.

An Executive Order was released stating that federal contractors must require COVID-19 vaccinations for all US employees. As a company that works on federal contracts, we have a legal requirement to comply with the executive order, if it is enforced.

Reporting to the Director of Clinical Quality, the Clin Ops Health Care Quality Strategist partners with Clinical Operations leadership on the improvement of member health outcomes and avoidable health care costs with a focus on experience, wellness, and most importantly the achievement of targeted HEDIS and CAHPS results. The individual in this position will apply the health care skills of critical thinking, effective problem solving, and decision making in an effort to influence not only to the care of our members, but to improve programs and processes across the organization. This individual will lead enterprise-wide projects, using a clinical approach, that make systemic improvements to GEHA’s ability to impact health outcomes for our members.

SKILLS

The Health Care Quality Strategist is a professional with broad experience and in-depth knowledge in health care quality and a strong business acumen. This individual will contribute to the organization’s strategic goals as well as act as an advisor to Senior Leadership inside and outside the division.

• Leads the transition of innovative ideas from pilot to implementation and shares best practices across relevant departments and leaders in order to improve HEIDIS and CAHPS, results.
• Has hands-on experience with health care accreditation. 
• Has industry level knowledge about NCQA, quality outcomes, and CMS, as well as digital measurement and interoperability.
• Assists in the interpretation of outcomes in order to develop operational improvements.
• Partners with the Analytics Division in identifying areas of opportunity, implementing process improvement, applying best practices, and provides recommendations to the Clinical Operations leadership. 
• Evaluates information regarding Proactive Care Management (PCM)/ Medical Management (MM) to determine whether intervention is necessary to improve members’ outcomes.
• Works across the organization coordinating tasks with multiple teams as needed to complete tasks or meet member needs. 
• Takes accountability for obtaining and maintaining all professional licenses.  Including CEUs and other trainings. 
• Facilitates appropriate use of resources and coordinates necessary services to improve health status and impact the cost of care.
• Critically thinks to solve problems.
• Proactively identifies potential barriers for members and helps create opportunities to steer them to positive health outcomes.
• Identifies blockers and subsequent interventions/service opportunities /appropriate care coordination opportunities for members to impact health and care outcomes.
• Helps set the clinical strategy to drive change for what quality initiatives will look like in 3-5 years.
• Works collaboratively across divisions within the organization
• Use data to trend and predict.
• Works autonomously with abstract directions to develop and lead new programs with minimal intervention needed.

Requirements

• BS in Nursing or related medical field of study.
• 5 years of experience working with HEDIS, Accreditation (NCQA, and CMS (Medicare Advantage STARS and ACO), UDS, PCMH, or quality programs.  
• Familiar with FHIR/Interoperability, EHR data, and electronic measures (ECDS/eCQM)
• Leadership experience both at the people and process level with proven ability to be innovative. 
• Healthcare regulatory knowledge
• Demonstrated strategic and operational knowledge
• The ability to work in abstracts with full autonomy
• Identifies barrier, exercises critical thinking skills, proposes and implements solutions across the organization. 
• Demonstrated experience in and enthusiasm for population health improvement and quality improvement.
• Experience with clinical quality metrics and strategies to impact scores in an operational environment.
• Demonstrated ability to work with peers to advance ideas and implement improvement programs. 
• Initiative, flexibility, integrity, and diplomacy
   

Preferred:

• MSN Master’s in related field or five years of relevant experience
• Certification in healthcare quality or eligibility required (CPHQ)
• Direct experience in quality assessment and improvement
• Experience with AAAHC Accreditation