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Manager - Quality Management

Integrated Resources, Inc

Washington, District of Columbia

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JOB DETAILS
JOB TYPE
Full-time
SKILLS
Administrative Management, Analysis Skills, Biology, Budgeting, Communication Skills, Consumer Assessment of Healthcare Providers and Systems (CAHPS), Content Management Systems (CMS), Contract Requirements, Data Analysis, Data Collection, Data Processing, Decision Support, Disbursements, Documentation, Employee Retention, External Quality Review Organization (EQRO), Financial Analysis, Health Informatics, Health Maintenance, Health Plan, Healthcare, Healthcare Effectiveness Data and Information Set (HEDIS), Healthcare Management, Healthcare Quality, Hewlett-Packard Product Family, Interpersonal Skills, Leadership, Maintain Compliance, Managed Care, Multicultural, National Committee for Quality Assurance (NCQA), Operational Audit, Organizational Skills, Performance Management, Policy Development, Presentation/Verbal Skills, Problem Solving Skills, Process Management, Program Evaluation, Progress Reports, Project Planning, Project/Program Management, Quality Assurance, Quality Management, Quality Metrics, Quality of Care, Regulations, Regulatory Compliance, Regulatory Requirements, Reporting Skills, Staff Requirements, State Laws and Regulations, Strategic Planning, Talent Management, Team Player, Time Management, Training Program Development, Training/Teaching Materials, Writing Skills
LOCATION
Washington, District of Columbia
POSTED
1 day ago
Manager - Quality ManagementIntegrated Resources, Inc., is led by a seasoned team with combined decades in the industry. We deliver strategic workforce solutions that help you manage your talent and business more efficiently and effectively. Since launching in 1996, IRI has attracted, assembled and retained key employees who are experts in their fields. This has helped us expand into new sectors and steadily grow.Job DescriptionUnder the direction of the Director, Quality Management, the Manager, Quality Management is responsible for providing oversight, daily administrative management, and direct supervision of the Quality Management team. This position is also responsible and accountable for maintaining the Health Plan's compliance with all state regulations and NCQA standards for quality activities related to Quality Management. This includes managing medical policy development, quality of care, health promotion, HEDIS interventions, accreditation as well as committee structure and support.Accountabilities:Responsible for the development, implementation and evaluation of the QM program (to include the work plan) and the Continuous Quality Improvement (CQI) plan under the guidance of the Chief Quality Officer.Participates in the planning, developing, and implementing Health Plan activities related to the HEDIS, CAHPS, accreditation, quality management programs, performance improvement projects, CLAS program, specified CMS Core Measures and AOP-specific initiatives. Identifies opportunities for clinical performance improvement and develops Quality Improvement Initiatives related to clinical performance and other quality activities.Maintains current knowledge of the Health Plan's Policy and Procedures and ensures program compliance to the governing regulatory body, NCQA HP and MCH Standards, CLAS standards, HEDIS and CAHPS. Participates in oversight activities as required by regulatory and accrediting bodies.Identifies barriers to project and program success and works toward resolution by informing the accountable executives and presenting plans to resolve the issue when possible. Maintains monitoring of issue until resolution or decision by the accountable executive to discontinue efforts toward resolving the issue.Responsible for meeting budget, organizational and departmental goals. Maintains optimal staffing patterns based on current Quality Management budget.Responsible for the management and development of new and existing staff. Works collaboratively with Performance Management to identify educational needs to staff and to maintain appropriate clinical expertise required to successfully perform daily responsibilities. Participates as indicated in the development and implementation of orientation and ongoing educational programs.Analyzes quality data from all sources and directs to appropriate committees and or accountable executives. Performs ad-hoc analysis of any underperforming or "broken" processes by collaborating with Subject Matter Experts and/or Customers to define existing processes and make recommendations for improvement.Ensures the timely creation of project plans, including measurements of outcome and productivity, and reports out progress to key stakeholders.Prepares reports and assessments of operational/services as required by departmental, corporate, and/or regulatory requirements. Works collaboratively with the Medical Informatics Department on identifying required data for reporting.Provides input into the development of educational material and programs necessary to meet the Health Plan's business objectives, members' needs, regulatory guidelines and staff professional development.Works in a collaborative manner with providers, members, and departments within the AmeriHealth Caritas Family of Companies to conduct ongoing process and data review to identify opportunities for improvement.Participates in interdisciplinary committees to maintain understanding and participation in projects and policies related to compliance with quality standards and or quality initiatives.Participates in coordination of internal and external Provider and or Member directed communication regarding issues impacting Quality Management.Acts as liaison for Quality Improvement staff and represents plan on state committees and workgroups whose focus is quality improvement projects, including EQRO, PIPS and other state initiatives.Responsible for creation and submission of state compliance documentation of activities and projects in his/her scope of responsibility.Uses data and analysis tools to identify opportunities for improved performance and collaborates with peers to develop intervention strategies.Responsible for the NCQA accreditation processes, Multicultural Healthcare Quality Distinction and all related reporting and analysis activities to include: production of reports and analysis to support executive leadership decision making; QM Department data collection and analysis activities that support NCQA QI Standard compliance.Works collaboratively with the key plan leadership and other stakeholders to assure NCQA delegation oversight compliance and timely disbursement of NCQA compliant member and provider communications.Supervises the processes for schedules, work plans, agendas, and minutes for committees that are part of the Quality Committee structure, and assures timely and accurate preparation of Quality Documentation to the health plan governance structure.QualificationsMUST HAVE PROVEN NCQA and PROJECT MANAGEMENT EXPERIENCEJob Related Requirements Knowledge/Qualifications/Skills/Abilities:Required Bachelor's Degree or equivalent work experienceRequired 3-5 years of management or leadership responsibilities in Quality Improvement.Required 5-8 years of progressively responsible experience in a health care or health plan related position.Required thorough knowledge of NCQA and state contract requirements.Required demonstrated ability to manage clinical and non-clinical staff.Required excellent organizational, analytical, and interpersonal skills.Required excellent written and verbal communication skills.Required ability to work successfully within all levels of the organization and with Enterprise partners.Required ability to design, develop and implement.Preferred Managed Healthcare experience.Additional InformationKind Regards,Kavita KumariClinical RecruiterIntegrated Resources, Inc.IT Life Sciences Allied Healthcare CRODIRECT # - 732-844-8726I'm interested

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Integrated Resources, Inc