Under the direction of the Director, Quality Management, the Manager of Quality Management is responsible for providing oversight, direct supervision and day-to-day management of the Quality Management Team. This position oversees integration of quality monitoring and interventions for improving HEDIS rates and provides process assistance to business owners for performance improvement projects. The incumbent provides direction and support to the Quality Management team and assists the Director in ensuring Plan compliance with state regulations and accreditation standards.
- Directs the Quality Operations Program, following the National Committee for Quality Assurance (NCQA) Standards and Guidelines Quality Management, as well as, the contract with the State and requirements of regulatory bodies
- Maintains current knowledge of Health Plan Policy and Procedures, State Requirements, NCQA Standards and HEDIS specifications.
- Participates in the planning, developing, and implementing Health Plan activities related to the HEDIS process, improving HEDIS rates and member satisfaction.
- Ensures the Quality Management Team complies with all applicable statutory provisions, contracts, and established policies and administrative procedures.
- Participates and assists in the development of all necessary protocols, policies and procedures, operational strategies and plans to develop and implement Quality Management programs.
- Ensures complete, accurate and timely reporting to regulatory bodies.
- Supports the development and implementation of quality management programs and pilot programs designed to improve HEDIS rates and/or member satisfaction.
- Identifies barriers to project and program success and works toward resolution by informing the accountable functional area and presenting plans to resolve the issue when possible.
Education/ Experience:- Bachelor's Degree in a Health Related field required.
- RN required
- 3 to 5 years management experience in Quality Improvement.
- 10 or more years progressively responsible experience in a health related position.
Other Skills:- Performance/Quality Improvement Coordinator (Manager) shall be a certified professional in healthcare quality (CPHQ) or certified in health care quality and management (CHCQM) or comparable education and experience in data and outcomes measurement required.
- Previous experience in managed care required.
Our Comprehensive Benefits PackageFlexible work solutions including remote options, hybrid work schedules, Competitive pay, Paid time off including holidays and volunteer events, Health insurance coverage for you and your dependents on Day 1, 401(k) Tuition reimbursement and more.
For roles that are 100% remote or hybrid, you must have access to a reliable high-speed internet connection to support daily job responsibilities. A minimum bandwidth of 50 Mbps download and 5 Mbps upload is required. Those fully remote associates residing in states where service is required by contract, law, or regulation will be allowed to submit for reimbursement.
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