DescriptionTitle: Manager, Quality Location: Fountain Valley Department: Utilization Management Status: Full-time Shift: Day Pay Range*: $114,712.00 - $172,078.40/annually Position Summary • The Manager of Quality is an experienced healthcare professional responsible for overseeing activities associated with improving performance, annual review and update of the quality improvement program descriptions as well as active review, discussion and collaboration with the QI Committee leadership and senior management.
• This individual will also be responsible for the ongoing monitoring and analysis of organizational performance, to assist in the design and implementation of quality improvement initiatives in support of the strategic objectives of the organization.
• Possesses a strong quality improvement background that includes experience in the acute and ambulatory settings as well as managed care, HEDIS and NCQA, specifically within government sponsored program environments.
• Will actively participate in maintaining a quality, risk and compliance management system that utilizes a structured, comprehensive review of the quality, safety and appropriateness of care delivered by the entire network of clinical services as well as monitor all service elements through appropriate study designs and sound statistical techniques when monitoring, conducting studies and developing report.
• Maintains oversight related to regulating the Plan's internal processes conforming and abiding by applicable state and federal regulations that governs Plan's entity
Essential Functions and Responsibilities of the Job - Responsible for the operational execution of the QM Program under the direction of the Director of UM/CM.
- Responsible for the development, implementation and evaluation of the QM Program and Work Plan.
- Responsible for the operations and management of staff assigned to all QM activities for MemorialCare Select Health Plan, including monitoring and reporting as required by regulation or contract.
- Responsible for managing the QM staff.
- Responsible for oversight of Antifraud Plan requirements;
- Oversees regulatory compliance;
- Responsible for the daily management and implementation of the Safety and Risk Management programs
- Acts as an educator and resource to all departments in matters involving Risk Management;
- Responsible for the compliance of MemorialCare Select Health Plan and providers' policies, procedures, education, communication, oversight, and enforcement;
- Reports QM activities to the Quality Council.
*Placement in the pay range is based on multiple factors including, but not limited to, relevant years of experience and qualifications. In addition to base pay, there may be additional compensation available for this role, including but not limited to, shift differentials, extra shift incentives, and bonus opportunities. Health and wellness is our passion at MemorialCare-that includes taking good care of employees and their dependents. We offer high quality health insurance plan options, so you can select the best choice for your family. And there's more... Check out our MemorialCare Benefits for more information about our Benefits and Rewards.
Qualifications Minimum Requirements • Current and unrestricted: RN (Registered Nurse) license OR Licensed Vocational Nurse (LVN) license, preferred
• A minimum of five (5) years' experience in a healthcare organization and familiarity with operational, financial and quality assurance procedures and regulations.
• Must possess the ability to seek out new methods and principles and be willing to incorporate them into existing practices
• Ability to work independently, with little supervision
• Experience working with Microsoft Office products, moderate word processing skills along with other basic computer proficiencies.
