RN Manager of Quality Management

Location: New York, NY
Date Posted: 03-30-2018
RN Manager of Quality Management - Managed Care
New York, NY (Manhattan, Battery Park area)

Manager of Quality Management Job Summary: 
  • Develops, implements and maintains a standardized quality management plan and program to ensure compliance with external regulatory and accreditation requirements.
  • Establishes and maintains tracking and monitoring systems for health care quality improvement activities according to regulatory requirements, accreditation standards, policies and procedures and contractual agreements.
  • Ensures high risk, high volume, and unusual events are monitored concurrently and retrospectively as they occur.
  • Researches and develops performance measurement and outcome studies to assess and improve the health status of the membership.
  • Plans, organizes and manages the design, development and analysis of a wide variety of topics relevant to health care services.
  • Designs and develops methodologies for preventive care and health care evaluations.
  • Researches and documents current health care standards for use in study design and methodologies.
  • Conducts preventive studies to evaluate the continuity and coordination of care and to assess the quality and utilization of health care services.
  • Provides assistance and guidance to clinical staff with regard to study design, methodology, data analysis and reporting.
  • Manages and evaluates performance of staff related to clinical and health care services performance improvement activities. Provides department orientation to new staff and ongoing staff development to the entire department.
  • Coordinates guidelines, studies and performance improvement activities in concert with the utilization management, quality management, pharmacy services, case management and disease management programs.
  • Maintains a knowledge base of HEDIS requirements and implementing clinical performance methods to improve HEDIS performance.
  • Prepares, compiles, reviews and submits monthly and quarterly reports for quality committee meetings.
  • Coordinates all external programmatic oversight visits for contracted providers and ensures timely completion and follow up on corrective action plans.
  • Coordinates the regular and systematic review of all potential adverse incidents in accordance with state statute.
Manager of Quality Management Background: 
  • Requires an active and unrestricted state Registered Nurse (R.N.) license.
  • Requires a Bachelor's Degree in Nursing or Health Administration.
  • Master’s degree in healthcare related field is preferred and can substitute for some of the required years of experience below.
  • 5 years of experience in in quality improvement, analysis, development, public health or related area, including at least 3 years in a healthcare organization.
  • 1+ year of management experience or in a project, senior or lead role directing teams
  • Prefer direct and recent experience at a health plan or other managed care organization (HMO/TPA/IPA/etc).
  • Familiarity with Medicaid/Medicare and state managed care practices, programs, and policies.
  • Experience in training / teaching staffs to meet operational requirements and goals.
  • Strong oral and written communication skills; ability to interact with all levels of internal and external contacts.
Erik Berg
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CareNational Healthcare Services

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