Healthcare Performance & Improvement Lead
WFA Digital Insight
The demand for healthcare operations specialists is on the rise, with a 25% increase in job openings in the past year. As the healthcare landscape continues to evolve, companies like General Dynamics Information Technology are seeking skilled professionals to drive quality assurance and performance monitoring. With the World Trade Center Health Program, this role offers a unique opportunity to make a meaningful impact. Candidates should be prepared to leverage their expertise in healthcare operations, quality management, and data analysis to succeed in this position.
Job Description
About the Role
The Healthcare Performance & Improvement Lead plays a critical role in ensuring the delivery of high-quality services to program members. As the primary owner of quality assurance activities, this individual will be responsible for directing quality assurance, performance monitoring, and continuous operational improvement initiatives. The role will involve collaborating with cross-functional teams to identify areas for improvement and implement changes that align with the program's strategic goals.Day-to-day, the Healthcare Performance & Improvement Lead will be responsible for maintaining a working mastery of functional and system Acceptable Quality Levels (AQLs), coordinating fulfillment of ad hoc information requests, and leading regular assessments of contractor compliance and performance. This role requires a strong understanding of healthcare operations, including claims adjudication, enrollment, certification, provider networks, and care coordination.
The ideal candidate will have experience working in federally regulated environments and supporting programs with high visibility and strict oversight requirements. They will be able to design and lead compliance assessments, trend analysis, and continuous improvement programs, and have a proven ability to leverage data analysis and reporting tools such as Power BI & Excel to track performance trends and improvement outcomes.
What You Will Do
- Serve as the primary owner of Quality Assurance (QA) activities, ensuring all contract tasks are performed accurately, consistently, and on time
- Maintain working mastery of functional and system Acceptable Quality Levels (AQLs), including what is monitored, how monitoring occurs, evaluation methodology, documentation practices, and reporting cadence
- Coordinate fulfillment of ad hoc information requests from the program related to performance oversight, audits, or formal reviews, ensuring responses are accurate and delivered on program-determined timelines
- Lead regular assessments of contractor compliance and performance, covering compliance with contract requirements, performance standards, and acceptable quality levels
- Identify and track administrative and clinical trends affecting member health, continuity of care, and stakeholder experience
- Align assessment findings with healthcare industry standards and best practices from other federal payers
- Translate assessment findings into actionable, continuous, proactive improvement initiatives aligned with program strategic goals and priorities
- Partner with cross-functional teams to ensure quality findings inform operational practice
- Collaborate with stakeholders to design and implement improvements to program operations
- Develop and maintain reports and dashboards to track performance trends and improvement outcomes
What We Are Looking For
- Bachelor's degree with 3+ years of experience in quality management, performance oversight, or compliance roles supporting federal healthcare programs, health plans, or TPAs
- Strong understanding of healthcare operations, including claims adjudication, enrollment, certification, provider networks, and care coordination
- Consulting experience in identification and implementation of improvement initiatives with functional teams and business users
- Experience working within federally regulated environments and supporting programs with high visibility and strict oversight requirements
- Demonstrated ability to design and lead compliance assessments, trend analysis, and continuous improvement programs
- Ability to leverage data analysis and reporting tools such as Power BI & Excel to track performance trends and improvement outcomes
- Strong written and verbal communication skills for stakeholder-facing reporting and audit liaison work
Nice to Have
- Experience with healthcare quality metrics and benchmarks
- Knowledge of federal healthcare regulations and guidelines
- Certification in quality management or a related field
Benefits and Perks
- Competitive salary and benefits package
- Opportunity to work on a high-impact program with a reputable company
- Collaborative and dynamic work environment
- Professional development and growth opportunities
- Flexible work arrangements, including remote work options
- Access to cutting-edge technology and tools
- Comprehensive health and wellness programs
How to Stand Out
- Develop a strong understanding of healthcare operations, including claims adjudication, enrollment, certification, provider networks, and care coordination
- Showcase your experience with data analysis and reporting tools, such as Power BI & Excel
- Highlight your ability to design and lead compliance assessments, trend analysis, and continuous improvement programs
- Be prepared to discuss your experience working in federally regulated environments and supporting programs with high visibility and strict oversight requirements
- Consider obtaining a certification in quality management or a related field to enhance your candidacy
- Research the company and program to demonstrate your knowledge and interest in the role
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