Manager of Quality Improvement

Telligen • West Des Moines, IA

4d • Hybrid

About The Position

The Manager of Quality Improvement is responsible for operational management, account management, and business development for specific contracts. The role manages diverse health management services, which may include population health management, practice facilitation, medical or utilization management, case, disease, or maternity management, and quality improvement activities. The manager monitors compliance with client and contract deliverables and applicable service and accreditation requirements, supervises program staff, and provides technical guidance and training related to contract and 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. Telligen is a 100% employee-owned population health management organization that offers clinical, analytical, and technical expertise to its partners. The company describes its culture as mission-driven and grounded in ownership, community, ingenuity, and integrity.

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 understanding 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; and managing conflict, including difficult conversations.
• Knowledge of financial principles, including budgeting.
• Ability to build and maintain 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 health care 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.
• Certified 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 dealing with sensitive information.

Responsibilities

• Manage the 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 continuous process-improvement methods.
• Facilitate national programs or projects, depending on the scope of the assigned area.
• Ensure operations are completed in a timely, satisfactory, and compliant manner within assigned funding and 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 by coaching, engaging, and supporting employees to achieve results.
• Provide resources and support needed to meet departmental and company goals and contract or program 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, skills, and certifications that support quality improvement and contract deliverables.
• Stay current on industry trends and changes.
• Perform miscellaneous duties as assigned.

Benefits

• The posting refers applicants to Telligen's Benefits Summary for a general description of benefits and other compensation.
• Telligen is a 100% employee-owned company, and employee-owners share in the company's success.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager