QUALITY PROGRAM MANAGER

AllCare Management Services•Grants Pass, OR

5h•Hybrid

About The Position

The Quality Manager supports the implementation and ongoing operations of the Quality Program for AllCare Health Plan, Inc and CCO. This role is responsible for coordinating day-to-day quality activities, including the collection, management, and preliminary analysis of quality data, and assisting in the preparation of reports to support organizational quality initiatives. The Quality Manager applies knowledge of Continuous Quality Improvement (CQI) methodologies and supports Performance Improvement Projects (PIPs), and quality measurement activities including HEDIS ®; CAHPS ®; HOS ®; HOS-M®; Medicaid Quality Measures; and Star Ratings ®. This role works under the direction of the Quality Director to ensure quality program activities are executed effectively and in alignment with regulatory requirements.

Requirements

May require a flexible schedule, hours may vary depending on work locations, meeting sites, and educational development opportunities.
May require the use of personal vehicle for local travel (subject to mileage reimbursement).
May require the use of a personal cell phone (cell phone stipend available).
Ability to perform essential job duties with or without reasonable accommodation and without posing a direct threat to safety or health of employee or others.
Bachelor's degree (B. A.) from four-year college or university; or one to two years related experience and/or training; or equivalent combination of education and experience.
Two to four years related experience and/or training in healthcare quality improvement, quality management, or related field.
Experience supporting quality programs within a managed care organization, Coordinated Care Organization (CCO), health plan, or healthcare delivery system.
Demonstrated experience working with quality metrics and reporting, including HEDIS ®, CAHPS ®, HOS ® and HOS-M®.
Experience working with healthcare data, including data collection, validation, analysis, and reporting.
Experience coordinating PIPs or other quality improvement initiatives.
Valid Oregon Driver’s License and vehicle insurance.
Proficiency in Microsoft Office Suite (Excel, Word, Outlook, Teams, SharePoint).
Experience with healthcare quality data tracking systems and documentation management.
Ability to prepare clear, accurate reports and presentations.
Knowledge of quality improvement methodologies and tools, such as PDSA cycles, root cause analysis, and process mapping.
Inclusive leadership and management: Bring a clear vision and recognize the value of divergent perspectives.
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.
Attentive, empathetic leadership: Enthusiasm for meeting and engaging with people.
Able to put people at ease, especially when there are lines of difference.
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.
Proactive problem solving: Proactively develop solutions to challenges, including by constantly looking at big-picture progress and thinking about people.
Flexibility: Ready to take advantage of unexpected opportunities; adapts quickly to change and is a teacher to assist with change within the organization.
Commitment to solving unresolved issues in an effort to collaborate and model problem solving.
Equitable Practices translates into plans for staff development, retention, strategy, and improving culture.
Ability to interpret and apply complex regulatory guidance, prepare clear and accurate reports, and communicate technical information to diverse audiences.
Skilled at documenting processes and findings, reviewing materials for accuracy and compliance, and facilitating meetings or presenting updates on quality initiatives.
Ability to analyze, interpret, and summarize quantitative data, including quality metrics and performance measures.
Skilled in performing basic statistical calculations, identifying trends, and preparing data-driven reports to support quality improvement initiatives and regulatory compliance.
Proficient in using spreadsheets, data visualization tools, and reporting software to organize, validate, and present data accurately.
Proficient in Microsoft Office Suite (Excel, Word, PowerPoint).
Experience with data analysis, reporting, and visualization tools.
Skilled in using healthcare data systems, electronic health records (EHRs), and quality or compliance tracking software to manage, validate, and present information accurately.
Ability to analyze and interpret complex data, identify trends and issues, and apply logical thinking to support quality improvement initiatives.
Skilled at making sound, evidence-based recommendations, solving operational problems, and escalating issues appropriately within organizational and regulatory frameworks.

Nice To Haves

Nursing degree or Master’s in Public Health preferred.
Experience working with disadvantaged populations and knowledge of health disparities are highly desired.
Prior experience providing day-to-day guidance or oversight to staff or project teams, preferred.
Certified in Quality or Quality Management, preferred.
Registered Nurse License, preferred.

Responsibilities

Supports the implementation and tracking of quality measures and initiatives.
Coordinates logistics and documentation for Quality Improvement (QI) Committee meetings, including agenda preparation and note-taking.
Assists in the preparation and validation of quality reports in collaboration with internal IT partners.
Coordinates with internal departments to support Quality Improvement Program activities.
Tracks and monitors quality data and escalate issues or trends to the Quality Director.
Maintains working knowledge of requirements from Centers for Medicare and Medicaid Services and the Oregon Health Authority and applies them to assigned tasks.
Participate in meetings as they relate to QI program.
Coordinates and supports the implementation of quality programs and initiatives, including: HEDIS ®, CAHPS ®, HOS ® and HOS-M®, ensuring activities are carried out in alignment with established plans and timelines.
Assist in the development, documentation, and execution of the Quality Assessment and Performance Improvement program (QAPI), Performance Improvement Projects (PIPs), Quality Improvement Projects (QIPs), Chronic Condition Improvement Projects (CCIP), and other quality improvement initiatives.
Compiles, analyzes, and maintains quality data and reports; collaborates with Information Systems staff to support data validation, reporting processes, and submission of materials to internal committees.
Coordinates quality management activities, including medical record review processes, quality audits, and support for committee and workgroup operations.
Supports the review and maintenance of quality-related policies and procedures by assisting with updates, documentation, and implementation of established processes.
Works cross-functionally with internal teams and providers to support adherence to quality standards, escalate issues, and facilitate improvement efforts.
Provides operational support and technical assistance to staff and subcontractors related to quality tools, reporting requirements, and program activities.
Assists in preparing required quality improvement materials and documentation for submission to regulatory and oversight entities, including the Oregon Health Authority and Centers for Medicare and Medicaid Services.
Maintains punctual, regular and predictable attendance.
Works collaboratively in a team environment with a spirit of cooperation.
Respectfully takes direction from the Chief Medical Officer and Director of Quality.
Meets all required training including those listed in Relias Learning Module System (LMS).
Other duties as assigned.
Directly supervises four employees in the Quality department.
Provides day-to-day oversight of assigned quality staff in accordance with the organization’s policies and applicable laws.
Supports onboarding and training.
Assigns and monitors work.
Provides input into performance evaluations.
Addresses routine staff questions and issues.
Escalates employee relations matters, including disciplinary actions and complex concerns, to the Quality Director.