QUALITY DIRECTOR

AllCare Management Services•Grants Pass, OR

3d•$100,000 - $120,000•Hybrid

About The Position

This position is responsible for maintaining an effective and robust Quality Program and providing overall direction, coordination, and implementation of the program for AllCare CCO and AllCare Health Plan, Inc. This will include the collection, management and analysis of quality data, and the preparation of quality reports.

Requirements

Ability to perform essential duties with or without reasonable accommodation and without posing a direct threat to safety or health of employees or others.
Valid Oregon Driver’s License and vehicle insurance.
Experience in leading a quality improvement program.
Knowledge of State and Federal health plan requirements.
Data Analysis & Interpretation
Quality Improvement Methodologies
Regulatory & Accreditation Knowledge
Project Management
Health Information Systems
Reporting & Communication Tools
Change Management & Training
Trust: Promotes honesty, transparency, and diligence. Approaches leadership with mindset of “power with” rather than “power over” and regularly includes others in planning and decision-making. Able to make and communicate difficult decisions in the best interest of AllCare Health.
Innovation: Ready to take advantage of unexpected opportunities; adapts quickly to change and is a teacher to assist with change within the organization. Commits to solving unresolved issues in an effort to collaborate and model problem solving. Proactively develop solutions to challenges, including by constantly looking at big-picture progress and thinking about people.
Relationships: Enthusiasm for meeting and engaging with people. Able to put people at ease, especially when there are lines of difference. Identifies and intervenes in problematic dynamics. Listens closely to understand needs or concerns and takes steps based on that input. Gets back to people in a timely manner. Takes pride in providing clear, helpful information.
Voice: Brings a clear vision and recognizes the value of divergent perspectives. Provides equity-centered conflict transformation support, interventions, and training in the team and across departments. Commits to and understands concepts of equity, belonging, and inclusion in the workplace. Effectively works and collaborates across differences. A working knowledge and understanding of the ways implicit bias, personal identity, and power and privilege impact individuals, organizations and systems.
Ability to read, analyze, and interpret the most complex documents.
Ability to respond effectively to the most sensitive inquiries or complaints.
Ability to write speeches and articles using original or innovative techniques or style.
Ability to make effective and persuasive speeches and presentations on controversial or complex topics to top management, public groups, and/or boards of directors.
Ability to work with mathematical concepts such as probability and statistical inference, and fundamentals of plane and solid geometry and trigonometry.
Ability to apply concepts such as fractions, percentages, ratios, and proportions to practical situations.
Job requires specialized computer skills. Must be adept at using various applications including database, spreadsheet, report writing, project management, graphics, word processing, presentation creation/editing, communicate by e-mail and use scheduling software.
Ability to define problems, collect data, establish facts, and draw valid conclusions.
Ability to interpret an extensive variety of technical instructions in mathematical or diagram form and work with several abstract and concrete variables.
The employee must occasionally lift and/or move up to 10 pounds.
While performing the duties of this job, the employee is regularly required to sit; use hands to finger, handle, or feel and talk or hear.
The employee is occasionally required to stand; walk and reach with hands and arms.
The noise level in the work environment is usually moderate.
The employee must be able to work onsite, as needed.
The employee must be able to work from a home office, as needed.
The employee must be able to travel, as needed.
Because of exposure to patient records of all types, the highest standard of patient confidentiality and privacy as established by business policy and HIPAA requirements must be maintained.

Nice To Haves

Master’s degree preferred.
Preferred Professional Certifications: CPHQ, HCQM, Lean Six Sigma, IAPP, and/or PMP

Responsibilities

Utilization of tools and systems for Continuous Quality Improvement, including analysis and interpretation of data.
Create, conduct and write Performance Improvement Projects.
Implement and lead HEDIS ®; CAHPS ®; HOS ®; Medicaid Quality Measures; and Star Ratings ® through all phases of these programs.
Designs and implements program evaluations of all aspects of the Quality Improvement and Quality Management Programs (QAPI Assessment).
Responsible for the development, monitoring and presentation of Quality Assurance Performance Improvement (QAPI) material and initiatives to the Quality Improvement Committee.
Responsible for the coordination of the Quality Improvement (QI) Committee, agenda setting, assigning scribes, and ensuring the meeting room is set up appropriately for each meeting.
Working with data science team to prepare and validate Quality reports and statistics.
Oversee and manages the Appeals and Grievance team, scheduling staff meeting, training staff on changes to processes that are based on OAR, CMS and/or CFR changes.
Facilitates communication and coordination among staff and departments to achieve QAPI objectives, ensuring compliance with regulatory requirements and organizational goals.
Develop, monitor, implement and report on Performance Improvement Projects (PIP), Quality Improvement Projects (QIP) and Chronic Condition Improvement Projects (CCIP).
Oversight and monitoring of the subcontractors Exhibit I associated material and deliverables.
Designs and reviews policies and procedures related to appeals, grievances, IRE, and quality management including methods of data collection, outcome performance measures, chart review procedures, analysis methodologies, and critical pathways analysis.
Compiles statistical data and writes narrative reports summarizing quality management findings.
Works with the data science staff to enhance data collection, analyze quality data, statistical and financial documents, and submit written and oral reports to the QI and Compliance Committee.
Help guide the Quality Improvement Committee in the Quality project topic selection, by presenting internal, national and state data and quality risk factors for review.
Works with staff, member, enrollees, and participants to mitigate risk to individuals’ potential Civil Rights violation and investigate any Civil Rights complaints.
Reviews QI Tools and surveys and provides technical assistance to staff and subcontractors.
Responds to inquiries related to quality and resource management issues from customers, staff, compliance agencies, and others.
Participates in OHA QHOC committee, various task forces, and seminars.
Maintains punctual, regular and predictable attendance.
Works collaboratively in a team environment with a spirit of cooperation.
Respectfully takes directions from the Chief Medical Officer and Chief Compliance Officer as appropriate.
Meets all required training including those listed in Relias Learning Module System (LMS).
Other duties as assigned.