Manager, Quality - Healthcare QA & HEDIS Exp Required - Remote US

Military Spouse Corporate Career Network

2d•Remote

About The Position

This position is responsible for HEDIS and NCQA Accreditation. The role involves overseeing assigned areas of quality within a specified unit of a SBU, implementing assigned quality program components, and interfacing with customers and regulatory entities. Responsibilities include managing day-to-day quality activities to ensure program and procedures support company goals for service, quality, and cost-effectiveness, as well as compliance with contract, federal, and state requirements. Activities may include interfacing with customers on quality programs, supervising quality staff, conducting training sessions on Continuous Quality Improvement (CQI) processes, coordinating quality initiatives, satisfaction surveys, and Advisory Groups. The role also involves tracking adverse incidents and Quality of Care concerns, monitoring performance measures, supporting provider profiling, conducting quality control audits, managing quality improvement projects, and preparing customer and site reports. Additionally, the position participates in quality committees to ensure timely recommendations for improving plan operations based on data from performance indicators, QI studies, and quality activities. The Manager, Quality serves as a liaison with assigned departments to integrate quality projects within operations and conducts internal audits of charts and clinical/service procedures for quality purposes.

Requirements

Bachelors degree in healthcare
Knowledge of HEDIS and NCQA
5+ years of healthcare quality improvement experience.
Knowledge of quality improvement processes and performance measurement.
Demonstrated skills in project management.
Strong interpersonal and organizational skills.
Expertise in word processing and data management software.
Healthcare Quality Work Experience

Nice To Haves

Master's degree in Behavioral Health
LSW - Licensed Social Worker - Care Mgmt

Responsibilities

Responsible for HEDIS and NCQA Accreditation.
Responsible for assigned areas of quality within a specified unit of a SBU.
Implements assigned quality program components.
Interfaces with customers and regulatory entities.
May have accreditation responsibilities based on contract requirements.
Manages day-to-day quality activities ensuring program and procedures support company goals for service, quality, and cost effectiveness as well as compliance with contract, federal and state requirements.
Activities and projects may include interfacing with customers on quality programs.
Supervises quality staff to ensure successful execution of projects and initiatives.
Conducts training sessions on Continuous Quality Improvement (CQI) processes.
Coordinates quality initiatives.
Coordinates satisfaction survey and follow-up.
Coordinates Advisory Groups.
Tracks adverse incidents and Quality of Care concerns.
Monitors performance measures.
Supports provider profiling.
Audits for quality control.
Conducts quality studies and manages quality improvement projects.
Prepares customer and site reports with assistance from Reporting and Analytics team.
Participates on quality committees to ensure quality issues are taken to the committee and recommendations are made, by the committee, in a timely manner.
Makes recommendations to the Committee for improving plan operations based on data from performance indicators, QI studies, and quality activities.
Serves as liaison with assigned departments to ensure quality projects are integrated within operations.
Conducts internal audits of charts and clinical/service procedures for quality purposes.