Allcare Health Jobs (NOW HIRING)

AllCare Health, Grants Pass, OR, US

Requisition ID: 1202

Salary Range: $100,000.00 To $120,000.00 Annually

AllCare Health offers competitive wages, an excellent benefit package including affordable healthcare, 401K retirement, wellness programs, and flexible schedule options.

Quality Director – Quality Department

This position is responsible for maintaining an effective and robust Quality Program and providing overall direction, coordination, and implementation for AllCare CCO and AllCare Health Plan, Inc. The role includes collection, management and analysis of quality data, and preparation of quality reports.

• Utilize tools and systems for Continuous Quality Improvement, including analysis and interpretation of data.
• Create, conduct and write Performance Improvement Projects.
• Implement and lead HEDIS, CAHPS, HOS, Medicaid Quality Measures, and Star Ratings through all phases of these programs.
• Design and implement program evaluations of all aspects of the QAPI Assessment.
• Develop, monitor and present Quality Assurance Performance Improvement material and initiatives to the QAPI Committee.
• Coordinate the QI Committee, set agendas, assign scribes, and ensure meeting room setup.
• Work with data science team to prepare and validate Quality reports and statistics.
• Maintain knowledge of Oregon Health Authority (OHA), CMS contract, and CFRs required quality program requirements.
• Oversee and manage the Appeals and Grievance team, schedule staff meetings, and train staff on process changes due to OAR, CMS, or CFR updates.
• Foster interdepartmental relationships and coordinate operations to support the Quality Improvement Program.
• Facilitate communication and coordination among staff and departments to achieve QAPI objectives, ensuring compliance with regulatory requirements and organizational goals.
• Develop, monitor, implement and report on Performance Improvement Projects (PIP), Quality Improvement Projects (QIP), and Chronic Condition Improvement Projects (CCIP).
• Oversee and monitor subcontractors' Exhibit I associated materials and deliverables.
• Design and review policies and procedures related to appeals, grievances, IRE, and quality management, including data collection methods, outcome performance measures, chart review procedures, analysis methodologies, and critical pathways analysis.
• Compile statistical data and write narrative reports summarizing quality management findings.
• Collaborate with data science staff to enhance data collection, analyze quality data, statistical and financial documents, and submit reports to the QI and Compliance Committee.
• Guide the Quality Improvement Committee in selecting project topics by presenting internal, national, and state data and quality risk factors for review.
• Work with staff, members, enrollees, and participants to mitigate risk of potential Civil Rights violations and investigate any Civil Rights complaints.
• Review QI tools and surveys and provide technical assistance to staff and subcontractors.
• Respond to inquiries related to quality and resource management issues from customers, staff, compliance agencies, and others.
• Participate in OHA QHOC committee, various task forces, and seminars.
• Maintain punctual, regular, and predictable attendance.
• Work collaboratively in a team environment with a spirit of cooperation.
• Respectfully take directions from the Chief Medical Officer and Chief Compliance Officer as appropriate.
• Meet all required training, including those listed in Relias Learning Module System (LMS).
• Perform other duties as assigned.

This position does not have on call responsibilities.

This position directly supervises four employees in the Quality department and carries out supervisory responsibilities in accordance with the organization’s policies and applicable laws. Responsibilities include interviewing, hiring, training, planning, assigning, and directing work; evaluating performance; following disciplinary and non‑retaliation policies; addressing complaints; and ensuring timely resolution of appeals and grievances.

• May require the use of personal vehicle for local travel (subject to mileage reimbursement).
• May require the use of a personal cell phone (cell phone stipend applicable).

Ability to perform essential duties with or without reasonable accommodation and without posing a direct threat to safety or health of employees or others.

Bachelor’s degree (BA) from a four‑year college or university in a related field. Master’s degree preferred.

• Four to ten years of related leadership experience in healthcare quality improvement.
• Experience utilizing tools for Continuous Quality Improvement, including analysis and interpretation of data; creating, conducting, and writing Performance Improvement Projects; implementing and leading HEDIS, CAHPS, HOS, Medicaid Quality Measures, and Star Ratings through all phases of these programs.

• Valid Oregon Driver’s License and vehicle insurance.
• Preferred professional certifications: CPHQ, HCQM, Lean Six Sigma, IAPP, and/or PMP.

• Experience in leading a quality improvement program.
• Knowledge of state and federal health plan requirements.
• Data analysis and interpretation.
• Knowledge of quality improvement methodologies.
• Regulatory and accreditation knowledge.
• Project management.
• Health information systems.
• Reporting and communication tools.
• Change management and training.

• Trust: Promotes honesty, transparency, and diligence. Approaches leadership with a mindset of “power with” rather than “power over” and regularly includes others in planning and decision‑making. Able to make and communicate difficult decisions in the best interest of AllCare Health.
• Innovation: Ready to take advantage of unexpected opportunities; adapts quickly to change and is a teacher to assist with change within the organization. Commits to solving unresolved issues in an effort to collaborate and model problem‑solving. Proactively develops solutions to challenges, including through constant big‑picture progress thinking.
• Relationships: Enthusiasm for meeting and engaging with people. Able to put people at ease, especially when there are differences. Identifies and intervenes in problematic dynamics. Listens closely to understand needs or concerns and takes steps based on that input. Returns to people in a timely manner. Takes pride in providing clear, helpful information.
• Voice: Brings a clear vision and recognizes the value of divergent perspectives. Provides equity‑centered conflict transformation support, interventions, and training across departments. Commits to and understands concepts of equity, belonging, and inclusion in the workplace. Effectively works and collaborates across differences. Possesses working knowledge of how implicit bias, personal identity, and power and privilege impact individuals, organizations and systems.

Ability to read, analyze, and interpret complex documents; respond effectively to sensitive inquiries or complaints; write speeches and articles using original or innovative techniques or style; and make effective, persuasive speeches and presentations on controversial or complex topics to top management, public groups, and/or boards of directors.

Ability to work with probability and statistical inference, fundamentals of plane and solid geometry and trigonometry, and apply fractions, percentages, ratios, and proportions to practical situations.

Proficiency with database, spreadsheet, reporting, project management, graphic, word‑processing, presentation creation/editing, email communication, and scheduling software.

Ability to define problems, collect data, establish facts, and draw valid conclusions; interpret extensive technical instructions in mathematical or diagram form and manage multiple variables.

The physical demands described are representative of those that must be met to successfully perform the essential duties of this job. The employee may occasionally lift or move up to 10 pounds. Routine duties include sitting, using hands, speaking, and hearing. Occasionally standing, walking, and reaching are required. Work noise is usually moderate.

• The employee must be able to work onsite as needed.
• The employee must be able to work from a home office as needed.
• The employee must be able to travel as needed.
• Maintaining the highest standard of patient confidentiality and privacy per HIPAA and business policy is required.

Monday–Friday 8:00 AM–5:00 PM (1‑hour unpaid lunch and two 15‑minute paid breaks). 40 hours per week.

AllCare Health Website: https://www.allcarehealth.com

All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sexual orientation, gender identity, sex, age, protected veteran or disabled status, or genetic information.