Sr. Director of Quality and Care Management
About The Position
The Senior Director of Quality and Care Management is responsible for leading and overseeing the organization’s quality assurance, compliance, and care management initiatives. This role ensures adherence to NCQA and CMS accreditation standards, develops and maintains policies and procedures, and implements strategies to enhance patient care outcomes. The Senior Director will manage audit processes, training programs, quality improvement initiatives, and grievance resolution, while also supporting fraud, waste, and abuse investigations. Additionally, they will oversee the Clinical Care Management Committee, ensuring governance structures align with regulatory requirements and organizational goals.
Requirements
- Bachelor’s degree in nursing or related field.
- 6-8 years of experience in Healthcare (Health Plan operation, Managed Healthcare)
- Strong understanding of NCQA and CMS accreditation requirements.
- Strong knowledge of home health, home infusion, and DME areas.
- Experience in utilization management, denials, and appeals Management.
- Proven self-starter and takes the initiative to identify and drive change.
- Exceptional written, oral, and interpersonal communication skills with both internal and external customers.
- Strong interpersonal, organizational, time management and critical thinking skills.
- Ability to work independently and manage multiple priorities.
- Ability to work effectively on a team and to lead a diverse team to a common goal.
- Analyze, understand, define, and deliver on client requirements.
- Manage multiple projects simultaneously.
- Proficiency in Microsoft office
- A strong work ethic
Responsibilities
- Leading and overseeing the organization’s quality assurance, compliance, and care management initiatives.
- Ensuring adherence to NCQA and CMS accreditation standards
- Developing and maintaining policies and procedures
- Implementing strategies to enhance patient care outcomes
- Managing audit processes, training programs, quality improvement initiatives, and grievance resolution
- Supporting fraud, waste, and abuse investigations
- Overseeing the Clinical Care Management Committee, ensuring governance structures align with regulatory requirements and organizational goals.
Benefits
- Medical, Vision, Dental, Short- and Long-term insurance
- 6+ Days of Holidays Pay
- 15+ days of PTO
- Employer paid life insurance
- 401K with employer contribution
- Wellness program with reward incentives
- Employee recognition and reward programs
- Offering Hybrid Remote/Telecommute Work Schedule
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What This Job Offers
Job Type
Full-time
Career Level
Director
