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.
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.
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
Master's Degree in Business, Health Care or Public Health (i.e., MPH, MHA, MBA, MPP, or Similar)
In lieu of degree, equivalent education and/or experience may be considered.
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
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.
Project Management and analytical/problem solving skills.
Certified Professional in Healthcare Quality (CPHQ)
Required Training Additional Information
Please see job description