Salary Range: $77,265.00 (Min.) - $100,445.00 (Mid.) - $123,625.00 (Max.)

Job Summary

The Quality Improvement Project Manager II is a healthcare project specialist who is 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. In this role, the Project Manager is 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 is detail-oriented and self-motivated.

This position works 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 Return of Investment (ROI) analysis. Comply with Request for Proposal (RFP) process for vendors every three years, followed by Request for Quotation (RFQ) in interim years. Documentation must be in compliance with company protocol.

Perform other duties as assigned.

Duties Continued

Education Required

Bachelor's Degree
In lieu of degree, equivalent education and/or experience may be considered.

Education Preferred

Master's Degree in Business Administration or Related Field

Experience

Required:

At least 3 years of experience in a managed health care environment.

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

Skills

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.

Statistical Analysis System (SAS) preferred

Licenses/Certifications Required

Licenses/Certifications Preferred

Certified Professional in Healthcare Quality (CPHQ)

Required Training

Physical Requirements

Light

Additional Information

Quality Improvement Accreditation:

Staff working in this area reports to the Manager, Quality Improvement Accreditation.

Quality Improvement Intiatives:

Staff working in this area reports to the Manager, Quality Improvement Intiatives.

Required:

Travel to offsite locations for work required.

Salary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change.

L.A. Care offers a wide range of benefits including

• Paid Time Off (PTO)
• Tuition Reimbursement
• Retirement Plans
• Medical, Dental and Vision
• Wellness Program
• Volunteer Time Off (VTO)