Director of Quality Improvement

Location: Syracuse, NY
Date Posted: 03-30-2018
CareNational
Director of Quality Improvement - Managed Care
Syracuse, NY
 
*** Generous Relocation Package available to attract top talent from around the Nation! ***

Job Summary:
 
The Director of Clinical Quality Improvement is responsible for strategically developing and coordinating Quality Improvement Program-related activities, objectives, and analysis within the health plan. This includes oversight of the day-to-day operations of the quality management department. The Director of QI provides ongoing maintenance and evaluation of systems and strategies to support the improvement of quality management accreditation through promoting and supporting innovation.  This position has oversight responsibilities for the quality of providers’ service delivery and overall performance reviews. Establishes strategic plans, policies, and procedures at all levels to ensure quality programs will meet or exceed guidelines or requirements and are consistent with overall quality strategies

Position Description:
 
Responsible for oversight of day to day operations of Quality Management department and all related activities.  Establishes quality improvement objectives; develops and implements the comprehensive Quality Management Program to meet the demographic and epidemiological needs of the population served.  Ensures compliance with federal, state, and accreditation standards by developing, implementing and maintaining compliance processes within the department.  Maintains audit readiness, by ongoing training, competency assessment, audit, monitoring of metrics and corrective action.  Promotes plan-wide understanding, communication, and coordination of QM programs.
The scope of quality improvement for this position is STAR ratings, HEDIS reporting and interventions, risk scores for Medicare and Medicaid, CAHPS, HOS, Rx adherence, NCQA accreditation, and client requested reports and projects. 
Responsible for ensuring compliance and providing direction and guidance on clinical quality improvement and management programs including National Committee for Quality Assurance (NCQA), URAC, or general accreditation.  Responsible for the reporting and analyzing of member care quality and for the development of plans and programs to support continuous quality improvement using HEDIS, QARR and other tools.  Acts as the liaison with government entities involved in HEDIS and the Performance Improvement Project.  
Maintains highly effective staff by selecting, developing, and training employees; communicating job expectations and monitoring job results; counseling and coaching employees; and by initiating, coordinating, and enforcing systems, policies, and procedures.  Work collaboratively with key health care professionals toward identification of opportunities for improvement, trend analysis, education and development of appropriate action plans for problem resolution.  Serve as a resource and leader working with research staff in study design, data collection, analysis, and reporting activities that support quality improvement interventions, transparency, compliance regulatory standards, and provider performance monitoring.  Ensure QM departmental policies and procedures are updated at least annually, new policies are developed as needed, and that all staff members are appropriately trained in updates.  Represents QM department by participating in assigned committees and interdisciplinary workgroups.  Serves as resource for internal and external customers including Medical Directors and provider organizations. 
 
Qualifications:
 
Prefers certification in either CPHQ or CHCQM, or equivalent.
Registered Nurse (RN) with a Bachelors’ of Science in Nursing (BSN) is preferred, but not required.
Requires Bachelor's Degree in Nursing or Healthcare related field.
Master’s degree in in health care related field or business administration is also preferred. 
At least 3-5 years previous management / supervisory experience, in roles of increasing responsibility.
3-5 years’ experience in Quality Management/Quality Improvement required, preferably with a Managed Care Organization (Health Plan IPA/HMO/TPA, etc), including success in leading population clinical intervention projects.
Requires at least 2 years’ experience working with Medicaid programs and populations.
Demonstrated experience with Healthcare Effectiveness Data and Information Set (HEDIS) and STARS gap analysis.
Prefer experience attaining National Committee for Quality Assurance (NCQA) accreditation
Intermediate computer skills, at a minimum, proficient in data analysis and MS Access, Word, PowerPoint, and Excel.
Demonstrated strength in strategic and analytical thinking, problem solving, communication (written and verbal), and presentation skills.
Demonstrated ability to engage and motivate staff toward success and achievement of common goals.
 
The Reward:

This growing organization is committed to the health and happiness of all their staff. They offer a comprehensive benefits package to all full-time, permanent employees including dental, vision, life, disability, flexible spending accounts (FSA), life and accident insurance, 401(k) after 30 days, ESPP (Employee Stock Purchase Plan), education/tuition reimbursement, paid holidays, generous PTO, with additional PTO offered through volunteer/community service program, and much more!
Prashant Patel
Account Manager
CareNational Healthcare Services
prashant@carenational.com
480.646.3275 (CALL – TEXT – FAX)
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