Network Quality Specialist

About SCAN

SCAN Group is a not-for-profit organization dedicated to tackling the most pressing issues facing older adults in the United States. SCAN Group is the sole corporate member of SCAN Health Plan, one of the nation's leading not-for-profit Medicare Advantage plans, serving more than 277,000 members in California, Arizona, Nevada, Texas and New Mexico. SCAN has been a mission-driven organization dedicated to keeping seniors healthy and independent for more than 45 years and is known throughout the healthcare industry and nationally as a leading expert in senior healthcare. SCAN employees are a group of talented, passionate professionals who are committed to supporting older adults on their aging journey, while also innovating healthcare for seniors everywhere. Employees are provided in-depth training and access to state-of-the-art tools necessary to do their jobs, as well as development and growth opportunities. SCAN takes great pride in recognizing our team members as experts in their fields and rewarding them for their efforts. If you are interested in becoming part of an organization that is innovating senior healthcare visit www.thescangroup.org, www.scanhealthplan.com, or follow us on LinkedIn, Facebook, and Twitter.

The Job

Are you excited by the idea of helping shape the senior healthcare space and partnering closely with providers? Our Network Quality Specialists drive performance improvement and quality initiatives with medical groups, IPAs, and integrated delivery systems. In conjunction with regional network efforts, builds provider relationships to deploy interventions with the goal of driving innovation and sustainable improvements in quality. Collaborate between Network Management, Network Relations, Risk Adjustment, Analytics, other SCAN business units, and network providers to achieve SCAN Health Plan's 5-Star goals.

To be successful in this role, you should possess a working knowledge and/or familiarity of clinical operations, population health management and driving quality improvement. Additionally, you must be an excellent communicator who thrives in a fast-past environment, is comfortable working with provider groups and cross-functional teams, and is highly organized.

You Will

Manages the performance, relationships and partnerships between SCAN and its providers by collaborating with cross-functional teams to improve clinical and quality metrics (HEDIS Gaps in Care, Rx, HOS, Member Experience, Access to Care) as outlined in SCAN's corporate goals and Provider Incentive Program (PIP).

Develop and implement initiatives based on data and best practices for targeted providers. Utilizes project management techniques to develop parameters and tracking tools to ensure adherence to project deadlines and outcomes. Conduct ongoing outreach and lead monthly quality check-ins with providers. Monitor, analyze and synthesize provider data to make clear recommendations to management for strategic initiatives. Prepares and presents presentations to stakeholders, summarizing recommendations to improve providers' clinical performance.

Ensure that there is a feedback loop of continuous improvement between SCAN and its providers, whereby outcomes of the implemented programs are reviewed for process improvement, with results being incorporated into future programs.

Assess provider group's population health management strategies and recommend appropriate interventions, SCAN programs and best practices to support 5 Star quality performance. Document, organize and summarize next steps as part of overall provider group account management. Travel onsite and engage with groups on quarterly basis or as needed.

Train provider groups on SCAN tools and reports to be used to increase provider performance. Escalate and problem solve as issues arise. Conduct additional analysis and think critically to determine root cause of issues (ex: data issue, resource issue, program effectiveness).

Contribute to the efforts of Network Quality by participating in interdepartmental meetings, select committees, and assigned projects.

Actively support the achievement of SCAN's Vision and Goals.

Other duties as assigned.

Your Qualifications

Bachelor's degree. A comparable combination of education/experience and/or training will be considered equivalent to the education listed.

3-5+ years' experience working in health care provider operations or an equivalent amount of experience in project management, population health management or quality improvement

Familiarity with healthcare markets and managed care.

Self-starter who can initiate and lead projects as well as navigate different environments.

Strong analytic, quantitative, and problem-solving skills required.

Strong verbal and written communication skills required.

What's in it for you?

• Base salary range: $58,200.00 to $93,100.00 per year
• Mostly Remote Work Mode
• An annual employee bonus program
• Robust Wellness Program
• Generous paid-time-off (PTO)
• Eleven paid holidays per year, plus 1 floating holiday, plus 1 birthday holiday
• Excellent 401(k) Retirement Saving Plan with employer match and contribution
• Robust employee recognition program
• Tuition reimbursement
• An opportunity to become part of a team that makes a difference to our members and our community every day!

We're always looking for talented people to join our team! Qualified applicants are encouraged to apply now!

At SCAN we believe that it is our business to improve the state of our world. Each of us has a responsibility to drive Equality in our communities and workplaces. We are committed to creating a workforce that reflects our community through inclusive programs and initiatives such as equal pay, employee resource groups, inclusive benefits, and more.

SCAN is proud to be an Equal Employment Opportunity and Affirmative Action workplace. Individuals seeking employment will receive consideration for employment without regard to race, color, national origin, religion, age, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender perception or identity, age, marital status, disability, protected veteran status or any other status protected by law. A background check is required.

#LI-CS2

#LI-Hybrid