Manage the quality department in the absence of the Director of Quality Management, including assuring the timely completion of all contact deliverables.
Serves as the primary lead in the development, operationalization and evaluation of the Engagement Center’s Quality Management plan including the application of CQI principles to conduct periodic assessments of program effectiveness.In collaboration with the Director of Quality, develops and implements an annual Quality Plan and Evaluation.
Responsible for Health Plan / client-specific performance improvement activities, and coordinating with the Quality Analytics team regarding data analysis related to such deliverables.
Represent Quality Department at Health Plans / client or other Hawaii-specific meetings where current quality activities including outcomes are discussed or presented.
Collaborate with the Accreditation Coordinator to conduct research, reporting, and data analysis focusing on NCQA and URAC accreditation activities and to ensure ongoing compliance with the accreditation standards.
As delegated by the Director of Quality, contribute to NCQA and URAC accreditation activities.
Participate in in Quality Improvement Activity (QIA) teams, and as appropriate assist teams in the development and refinement of quality improvement activities using NCQA standards
Support completion and delivery of all Hawaii-specific reports and documentation; develop and implement procedures for reporting and delivery for overall and plan-specific reports.
Participate in the BEACON Quality Improvement Council (QIC) as a full voting member.
As indicated, collaborate with the BEACON Corporate Quality Manager to support BEACON-specific HEDIS activities.
Contribute to the development of new Policies and Procedures or the revision of existing P&Ps as directed by the Director of Quality.
Collaborate with the Quality leadership team to oversee key departmental activities and to further departmental goals.
Participate in implementation of new contracts.
Assist in all areas of quality improvement throughout Beacon, including preparing and presenting staff trainings on issues related to Quality as part of Beacon’s Employee training program requirements.
Analysis of current processes and development of new or revised Work Flow documents for quality and clinical programs to improve efficiency, accuracy and compliance.
In collaboration with the clinical department, facilitate treatment record review process to ensure in compliance with NCQA, URAC, state and Federal standards / regulations.
Implement trainings and develop resources for Quality Management staff and other Beacon teams regarding CQI tools and process improvement strategies.
As Co-chair of the Quality Management Committee (along with the Medical Director), the Quality Manager is responsible for organizing the QMC/UMC, overseeing the development of the agenda, and quality related reports.The QM Manager is responsible for maintaining the QM pertinent documents related to the work of the committee as needed for accreditation.
Assumes primary responsibility for maintaining NCQA and URAC accreditation (as applicable).Acts as lead on Engagement Center participation in audits and accreditation or certification through national credentialing bodies such as NCQA or URAC.
Supervises and evaluates performance of Quality Analyst.
Interfaces with external and internal customers to ensure on-going quality improvement activities, accreditation requirements, and prevention programs
Performs other duties as assigned.