Clinical Operations Manager
Sunday Health
Director, Marketing Quality Improvement
CareSource
full-time
Posted on:
Origin: • 🇺🇸 United States • Ohio
Visit company websiteSalary
💰 $110,800 - $193,800 per year
Job Level
Lead
About the role
- The Director, Market Quality Improvement is responsible for directing activities to achieve defined quality goals and outcomes and improve quality performance for assigned market(s).
- Executes Quality Improvement program for assigned market(s) while ensuring that quality improvement goals, outcomes, and market compliance with NCQA accreditation and quality requirements, as well as state requirements, are met
- Develops, organizes, and monitors the Quality Improvement Program, Quality Improvement Plan and QAPI processes annually, and guides their implementation
- Annually collaborates with stakeholders, reviews, incorporates recommendations, and communicates the Quality Improvement Programto appropriate stakeholders by defined time limits
- Annually evaluates the previous year’s Quality Improvement Program to collaboratively develop the work plan for the upcoming year
- Analyze potential member risk data and quality data to improve quality performance and care for members across organizational lines of business
- Oversees and/or chairs workgroups and committees, to improve quality measure outcomes in their respective market
- Collaborates with business owners across the enterprise to successfully deliver quality related standards in compliance within defined timeframes
- Ensures quality requirements are met through continual review, audit and monitoring of quality improvement / performance improvement activities
- Responds to administrative inquiries related to quality issues or audits; oversees the development of corrective action plans, as needed
- Oversees analysis, including root cause analyses, with support from identified business owners and departments; ensures data is presented and used effectively to address quality and performance improvement identified issues
- Participates in community-based initiatives related to QI program initiatives
- Establishes and maintains standards and procedures for quality reporting and documentation and communicates areas of strengths as well as opportunities for improvement through the Quality Committees
- Externally represents CareSource to appropriate state-based committees, consultants, representatives, and accreditation authorities
- Oversees performance improvement projects as directed by state regulators
- Ensures compliance with regulatory quality reporting requirements and maintains an in-depth knowledge of the company’s business and regulatory and accreditation environments
- Aids in the budgeting and financial forecasting/ analysis process
- Assists in strategic planning and prioritizes staff workload
- Perform any other job related instructions, as requested
Requirements
- Bachelor of Science in Nursing (BSN) or other degree in a healthcare, business, management or related field is required
- Masters in Nursing, Business, Management or related field is preferred
- Minimum of five (5) years of leadership/management experience is required
- Minimum of three (3) years of experience in Medicaid, or a managed care organization is required
- Minimum of five (5) years of healthcare quality experience to include developing, implementing and/or evaluating Quality Improvement Programs is required
- Experience in data collection, analysis and trending of processes and outcomes
- Intermediate computer skills; proficient in Microsoft Word, Excel, and PowerPoint
- Demonstrated understanding of complex healthcare industry, health plan and business processes specific to quality and performance Improvement, and quality methodology.
- Demonstrated experience in a high-growth business environment.
- Strong presentation skills
- Ability to work in a demanding environment and quickly reprioritize based on needs.
- Effective critical thinking skills with attention to detail
- Ability to develop, prioritize and accomplish goals.
- Effective communication skills (both written and verbal) and ability to work with multi-disciplinary departments across the organization to achieve goals that are dependent on multiple areas across the enterprise.
- Strong people skills and high level of professionalism
- Ability to work independently and within a team environment.
- Active listening and critical thinking skills
- Strategic leadership/management skills
- Customer service, member-focused orientation
- Certified Professional in HealthCare Quality (CPHQ) by the National Association for Healthcare Quality (NAHQ) within six (6) months of employment is required
