RN Manager, Quality Improvement & Performance
About The Position
The Manager, Quality Improvement implements quality improvement programs for the Kentucky Medicaid line of business. This includes quality compliance and quality improvement activities such as the annual Quality Improvement program description, work plan, and annual evaluation, as well as oversees, plans, and implements new and existing health plan quality improvement initiatives, including Performance Improvement Projects (PIPs), medical records documentation audits, and Early Periodic Screening Diagnosis and Testing (EPSDT). The Manager, Quality Improvement works within specific guidelines and procedures; applies advanced technical knowledge to solve moderately complex problems; receives assignments in the form of objectives and determines approach, resources, schedules and goals. The Manager, Quality Improvement is responsible for monitoring and implementing activities related to quality improvement and quality compliance for both behavioral and physical health. The Manager, Quality Improvement is responsible for developing, implementing and monitoring the success of the quality assurance and performance improvement program and monitoring the success of quality improvement interventions, including EPSDT. The Manager, Quality Improvement works to coordinate resources and manages department reporting, audits processes as needed for compliance, completes and submits reports to internal committees and state regulators as required. Decisions are typically related to resources, approach, and tactical operations for projects and initiatives involving own departmental area. Requires cross departmental collaboration and conducts briefings and area meetings; maintains frequent contact with other managers across the department. The Manager leads a team of both clinical and non-clinical associates and will need to travel as needed for state meetings and participate in other internal and external multidisciplinary meetings.
Requirements
- Active Registered Nurse (RN) license in Kentucky, in good standing and without disciplinary action.
- 5+ years of experience in health plan quality improvement and/or quality compliance.
- 5+ years of experience with healthcare quality measures, such as HEDIS and CAHPS.
- 3+ years of experience leading member-facing professionals or conducting direct member engagement, with demonstrated results.
- 3+ years of demonstrated experience analyzing data and preparing formal, data-driven reports.
- Comprehensive knowledge of Microsoft Office applications, including Word, PowerPoint, Excel, and Teams
Nice To Haves
- Experience with Kentucky Medicaid.
- Bilingual proficiency.
- Certified Professional in Healthcare Quality (CPHQ) certification.
- Project management experience.
Responsibilities
- Managing daily operation of member/provider outreach program
- Managing ongoing medical record documentation review for physical and/or behavioral health
- Managing on-going quality improvement activities for both physical and behavioral health based off analysis of performance measures (example HEDIS, CAHPS) or other quality measures (other satisfaction surveys, or other access or services measures)
- Managing EPSDT processes and performance
- Monitoring and reporting progress towards goals for performance and focus measures.
- Completing quality related reports for various state and internal committees
- Participating in interdisciplinary quality improvement workgroups and committees, both internal and external
- Managing and updating Quality program documents including the quality improvement program description, quality improvement work plan, and quality improvement evaluation as appropriate
- Other activities as assigned
Benefits
- medical, dental and vision benefits
- 401(k) retirement savings plan
- time off (including paid time off, company and personal holidays, paid parental and caregiver leave)
- short-term and long-term disability
- life insurance
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What This Job Offers
Job Type
Full-time
Career Level
Manager
Education Level
No Education Listed
