Manager of Quality Improvement

Telligen•West Des Moines, IA

7d•Hybrid

About The Position

The Manager of Quality Improvement is responsible for operational management, account management, and business development for assigned contracts. The role manages health management services that may include population health management, practice facilitation, medical or utilization management, case, disease, or maternity management, and quality improvement activities. It monitors compliance with client and contract deliverables and applicable service and accreditation requirements, and supervises program staff while providing technical guidance and training related to program operations. This is a hybrid position requiring onsite work at the West Des Moines, Iowa office on Mondays and Fridays, and potentially on other days as needed. Assigned contracts may require U.S. citizenship.

Requirements

Four-year degree in nursing.
Current Iowa RN license or ability to become licensed in Iowa.
Five years of experience in medical coding and utilization management, including claims, billing, prior authorization, and appeals.
Three to five years of experience managing projects and professional staff.
Demonstrated experience working in a fast-paced, deadline-driven environment.
Experience with URAC and NCQA health plan accreditation specific to utilization management.
Experience with claims post-pay medical necessity reviews.
Experience reviewing medical codes for coverage determinations, including establishing medical policy, and demonstrated knowledge of how utilization management and medical policy support evidence-based coverage determinations.
Knowledge of code update implementations, including ICD-10 and CMS.
Knowledge of strategic planning, implementation, and evaluation; leading change; coaching, guiding, and training people; conflict management and difficult conversations; financial principles including budgeting; and building and maintaining stakeholder relationships.
U.S. citizenship may be required for positions working on specific contracts.

Nice To Haves

Knowledge of healthcare quality principles, including health care services, organizations, and programs.
Knowledge of information management processes, electronic health records, and healthcare information technology.
Knowledge of quality improvement concepts, principles, and process tools.
Knowledge of basic statistics, data collection techniques, data analysis, and graphic representation of data.
Familiarity with Iowa HHS Administrative Rules and Administrative Rule Waiver.
Certification as a professional in coding and billing.
Facilitation experience, including group process facilitation.
Knowledge of the QI process: Focus-Analyze-Develop-Execute and Plan-Do-Study-Act.
Experience handling sensitive information.

Responsibilities

Manage day-to-day operations of multiple and diverse health management service lines, contracts, or programs.
Lead the team in creating, implementing, evaluating, and managing strategic plans to meet or exceed contract deliverables, program requirements, and evaluation measures or metrics within assigned funding and budgets.
Facilitate analyses and action plans when deliverables or requirements are at risk.
Develop and maintain relationships with team stakeholders.
Provide technical assistance, including researching and resolving issues.
Develop and implement process improvement methods in support of continual improvement.
Facilitate national programs or projects, depending on the scope of the assigned area.
Ensure operations are completed on time, satisfactorily, and in compliance with requirements and assigned funding or budgets.
Participate in sales, business development, and proposal activities, including developing concept papers and contributing to or reviewing proposals as a subject matter expert.
Monitor budgets and financials for assigned contracts.
Coach, guide, and direct team members to achieve individual, team, and organizational objectives.
Fulfill the Telligen Management Philosophy that managers coach, engage, and support employees to achieve results.
Provide resources and support to meet departmental, company, and contract or program goals and requirements.
Represent the company and present at meetings or conferences.
Work externally with providers or clients as assigned.
Recommend improvements or efficiencies to management.
Pursue opportunities to expand knowledge, develop skills, and earn certifications that support quality improvement and contract deliverables.
Stay current on industry trends and changes, and perform other duties as assigned.