Manager, Market Quality Improvement - Must Reside in Georgia

CareSource•Atlanta, GA

12d

About The Position

Job Summary: The Manager, Market Quality Improvement manages the day-to-day prioritization of staff activities in collaboration with Director, Quality Improvement. The Manager will be responsible for developing quality documents in compliance with state and federal requirements and work with departments outside of quality to obtain information for reports. Essential Functions: Responsible for Corporate oversight of the HEDIS Medical Record Review Unit as needed for the assigned market Responsible for development and oversight of Quality Improvement (QI) Projects and Performance Improvement Projects related to HEDIS and pay for performance (P4P) requirements Ensures compliance with External Quality Review audits/studies, Performance Improvement Projects, and Quality Improvement Projects required by the state, NCQA, and other accreditation bodies Responsible for the review of QI issues regarding compliance with Federal, State, and Accreditation requirements Ensure all policies and procedures are aligned with Federal, State, and Accreditation requirements Responsible for the annual review, program description, program plan, and update of QI Department policies and procedures Provide education to internal and external customers on quality improvement functions Respond to questions that pertain to HEDIS and Quality Improvement from providers and internal staff members Foster relationships with all internal departments and represents CareSource to community-based and state programs Collaborate with business owners to establish, implement, and develop best practices for P4P quality directives Implement opportunities for process improvement that impact quality measurements in assigned market Monitor industry trends as it relates to healthcare and identify areas of opportunity for improvement Responsible for ensuring business owners successfully complete all deliverables related to performance improvement plans (PIPs) and quality improvement plans (QIPs) within defined timeframes Conducts analysis, including root cause analyses with support from identified business units and ensure data is presented and used efficiently to meet the quality goals Follows enterprise standards and procedures for all quality reporting and documentation and communicate areas of strengths as well as needs to the Quality Improvement Committee Perform all facets of quality management to include the development of detail work plans, setting deadlines, assigning responsibilities and monitoring/summarizing project progress Establish, monitor and review mechanisms to assess and document each business units level of compliance with each measure and coordinate corrective actions Attends and participates in market quality committees Guide and direct successful completion of daily tasks and projects Interview, select and train new team members Conduct performance management activities for direct reports, to include monthly one-on-one meetings, annual performance appraisals, and discipline as appropriate Perform any other job related instructions, as requested

Requirements

Bachelor’s Degree or equivalent years of relevant work experience is required
A minimum of three (3) years of experience in a healthcare or managed care organization is required
Previous management experience is required
Intermediate proficiency in Microsoft Word, Excel and PowerPoint
Solid leadership skills; able to effectively manage a high performing team, provide coaching and development
Demonstrated ability to adjust and shift priorities, multi-task, work under pressure and meet deadlines
Proven ability to recognize opportunity for improvement and lead change
Data analysis and trending skills
Effective communication skills
Prior supervisory skills
Ability to work independently & in a team environment
Training/teaching skills
Time management skills
Critical listening and thinking skills
Strategic management skills
Decision making/problem solving skills
Customer service oriented

Nice To Haves

Completion of an accredited Registered Nursing degree program or Bachelor’s of Science in Nursing (BSN) is preferred
Master’s Degree in Nursing (MSN), Public Health, or healthcare related field is preferred
Medicaid and/or Medicare experience preferred
Experience in quality metrics preferred
Current, unrestricted Registered Nurse (RN) licensure in the state of practice is preferred
Certified Professional in Healthcare Quality (CPHQ) is preferred

Responsibilities

Responsible for Corporate oversight of the HEDIS Medical Record Review Unit as needed for the assigned market
Responsible for development and oversight of Quality Improvement (QI) Projects and Performance Improvement Projects related to HEDIS and pay for performance (P4P) requirements
Ensures compliance with External Quality Review audits/studies, Performance Improvement Projects, and Quality Improvement Projects required by the state, NCQA, and other accreditation bodies
Responsible for the review of QI issues regarding compliance with Federal, State, and Accreditation requirements
Ensure all policies and procedures are aligned with Federal, State, and Accreditation requirements
Responsible for the annual review, program description, program plan, and update of QI Department policies and procedures
Provide education to internal and external customers on quality improvement functions
Respond to questions that pertain to HEDIS and Quality Improvement from providers and internal staff members
Foster relationships with all internal departments and represents CareSource to community-based and state programs
Collaborate with business owners to establish, implement, and develop best practices for P4P quality directives
Implement opportunities for process improvement that impact quality measurements in assigned market
Monitor industry trends as it relates to healthcare and identify areas of opportunity for improvement
Responsible for ensuring business owners successfully complete all deliverables related to performance improvement plans (PIPs) and quality improvement plans (QIPs) within defined timeframes
Conducts analysis, including root cause analyses with support from identified business units and ensure data is presented and used efficiently to meet the quality goals
Follows enterprise standards and procedures for all quality reporting and documentation and communicate areas of strengths as well as needs to the Quality Improvement Committee
Perform all facets of quality management to include the development of detail work plans, setting deadlines, assigning responsibilities and monitoring/summarizing project progress
Establish, monitor and review mechanisms to assess and document each business units level of compliance with each measure and coordinate corrective actions
Attends and participates in market quality committees
Guide and direct successful completion of daily tasks and projects
Interview, select and train new team members
Conduct performance management activities for direct reports, to include monthly one-on-one meetings, annual performance appraisals, and discipline as appropriate
Perform any other job related instructions, as requested