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Quality Improvement Project Manager

L.A. Care Health Plan Los Angeles, United States Full-Time
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Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members in six health plans, we make sure our members get the right care at the right place at the right time.



Job Summary


The Quality Improvement (QI) Project Manager is a healthcare project specialist who will be responsible for managing day-to-day operations of a portfolio of projects, and providing support for ongoing special projects within L.A. Care's Quality Improvement Department. This position will report to the QI Accreditation Manager. In this role, the project manager will be responsible for ensuring program activities are completed in a high quality and timely manner and ensuring compliance with all regulatory guidelines such as Medicaid (Medi-Cal), Medicare, Health Exchange, and Healthy Kids as well as National Committee for Quality Assurance (NCQA) Accreditation. Successful candidate must have excellent project management, analytic, reporting, and written and oral communication skills. In addition, candidate should be detail-oriented and self-motivated.

The QI Project Manager will work on various quality improvement projects including, but not limited to:
  * Implementation of any new product lines;
  * Data collection and analysis using internal data and using various analytic tools to develop interventions
to improve overall member satisfaction, such as grievances and appeals data, CAHPS surveys, Healthcare Effectiveness Data and Information Set (HEDIS) results and network access and availability.
  * NCQA Accreditation readiness and oversight.
  * Delegation oversight.
  * Vendor contract management and operations.
  * Nurse Advice Line management and oversight.
  * Inter-departmental committee participation.

Duties

Design and management of a portfolio of assigned projects within budget to: Ensure that projects are delivered timely, accurately and in compliance with all regulatory requirements and NCQA Standards and within other established metrics. Present quarterly quantitative and qualitative performance analysis and reports to Quality Oversight Committees as well as other committees. Monitor the performance of current service interventions as well as coordinate new interventions

Process analysis, process evaluation and assist in implementing process improvements to: Ensure Business Process Improvement meets requirements and expected business benefits. Develop appropriate project management tools to develop, implement and evaluate current projects. At least annually, assess projects to determine if they are meeting performance goals and provide project plan for continuous quality improvement.

Identify, recommend and apply business solutions, derived from findings of research and analysis. Gain departmental efficiencies.

Documentation of existing business processes and industry best practices by: Workflows of existing processes and interdependencies. Complete and accurate work plans for all assigned projects. Complete business requirements for analytical tools used to measure project improvement.

Lead vendor selection processes, implement and manage vendor contracts by: A successful selection of vendors with positive ROI analysis. Comply with RFP process for vendors every three years, followed by RFQ in interim years. Documentation must be in compliance with company protocol.

Perform other duties as assigned.

Education Bachelor's Degree Experience

Required:
Bachelor's Degree

Preferred:
Master's Degree in Business, Health Care or Public Health (i.e., MPH, MHA, MBA, MPP, or Similar)

Equivalent:
In lieu of degree, equivalent education and/or experience may be considered.

Required:
At least 3-5 years experience in a managed health care environment.

Experience with health care program design, implementation, and evaluation.

Experience in a managed health care environment; knowledge of regulatory requirements for Medicaid, Medicare, and NCQA standards

Required:
Knowledge of regulatory requirements for Medicaid, Medicare, and NCQA standards.

Strong data management and analytic skills (including basic statistics or better).

Proficiency in analytical tools (SPSS) and Microsoft office (Excel, MS Project, Access, Visio); including the ability to develop databases, forms, letters, and advanced queries.

Ability to lead project team, meet or exceed deadlines and work with other dependencies outside the department related to the project.

Excellent written and oral communication skills.

Strong interpersonal communication skills with ability to effectively work with staff at all levels of the organization

Persuasion Skills: Persuade internal L.A. Care staff to attend and participate in collaboration of service improvement activities and complete tasks and activities in timely manner. Obtain reports from internal staff.

Preferred:
Project Management and analytical/problem solving skills.

SAS preferred

.

Professional Certifications


Preferred:
Certified Professional in Healthcare Quality (CPHQ)

Required Training Additional Information

Please see job description

 

Skills required

Negotiation
Forecasting Information
Time Management
Resolve Issue
Problem Solving
Provide Direction

Location

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Quality Improvement Project Manager
Estimated Salary: $90K
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Job ID: 4704

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What We Do

Established in 1997, L.A. Care Health Plan is an independent local public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 1.8 million members in five health plans, we make sure our members get the right care at the right place at the right time.

Health Coverage

We offer a variety of affordable health plans for the diverse communities of Los Angeles. Our health plans provide access to a wide network of local doctors, hospitals and pharmacies.

Community Engagement



Regional Community Advisory Committees



With 11 Regional Community Advisory Committees (RCACs),
health plan members have a voice and keep us connected to the needs of the
people we serve. Members join the RCAC in the region where they live.
Community-based organizations (CBOs) and advocate groups are also welcome to
participate.



Family Resource Centers



Our Family Resource Centers provide free health education
classes, exercise classes or health screenings. Members can also get help with
picking a doctor, making appointments or member information.



Health Promoters



Our Health Promoters program is a grassroots health outreach
and education effort that trains members to discuss health topics with the
public at workshops and health fairs. They provide health-related resources to
people who live in their areas through the use of theater, workshops and health
fairs.



Speakers Bureau



We offer our Speakers Bureau as a free service to
associations and organizations in Los Angeles County to help educate our
community about health care, health care reform, and programs available through
L.A. Care and our partners. Speakers include doctors, nurses, trained health
promoters and other health care experts with a wide range of expertise.



Health Care Partnerships



To help our network providers deliver quality and
compassionate care to our members, we provide them with a variety of tools and
resources, including health education materials, continuing education classes,
and behavioral health resources.

Our support also includes technological advances to promote
effective coordinated care. L.A. Care designed Health Information Technology
Extension Center for Los Angeles (HITEC-LA) to assist all Los Angeles County
health care providers with implementing and meaningful use of electronic health
records.

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