Manager of Quality Care Improvement
Location: El Monte *IN OFFICE* position (w/safety measures)
Permanent/Full Time opportunity with leading Managed Care organization in the San Gabriel Valley!
NOTES: Also have an opening for a Specialist and Supervisor of Quality Care!!
Lead and develop the Quality Care Improvement Department and provide supervision and oversight to all personnel and functions they perform. The manager will oversee the QCI department in coordinating the HEDIS & Star Quality measures activities and will work as a liaison with Health Plan’s and IPA clients on Quality Improvement projects.
ESSENTIAL DUTIES AND RESPONSIBILITIES FOR Manager of Quality Role
- Responsible for the overall department operations, monitoring and compliance of all HEDIS & Star Rating activities and performance for all IPAs managed
- Provide direction and support for all HEDIS related projects and interventions to include but not limited to medical record abstraction, aimed at improving HEDIS & Star rating rates
- Facilitate and lead ongoing discussions concerning data collections, study design, methodology, and data analysis for HEDIS and Star Measure projects
- Lead the department in the development of new HEDIS interventions and corrective action plans for measures that fall below health plan benchmark goals
- Participate in strategic planning in anticipating market needs and develop innovative responses to address future needs and challenges through planning and management of QCI
- Oversee the maintenance and update of IPA Provider Database
- Support the providers in preparing infrastructure for quality management implementation through activities such as advising on proper documentation, billing and coding, pre-screening appointments and helping to improve HEDIS scores
- Communicates the vision for change through activities such as presenting best practices and standards of quality of care with preventive care program, annual wellness visit, HEDIS, and Star measures
- Facilitate and perform HEDIS & Star Quality Measure trainings
- Attend all Health Plan, CMS, DHCS, NCQA, and all other relevant trainings and technical content webinar training.
- Participate in staff hiring efforts and evaluation of performance during introductory and annually with Supervisor - QCIT
- Attend to health plans, provider, and interdepartmental calls in accordance with exceptional customer service; maintain professional and appropriate behavior (actions/verbal) at all times
Qualifications for Manager of Quality Roel
· Minimum of BA/BS degree
· 5+ years of IPA/MSO experience required; 2+ years of supervisory/management experience required
· Knowledge of managed care and health plan standards
· Experience with Chronic Care Model, Model of Improvement and general quality improvement methods
· Experience with and understanding of outpatient clinical settings
· Excellent oral and writing skills characterized by the ability to communicate effectively with varying audiences
· Must be detail oriented and possess strong organizational skills in a fast-pace environment
· Highly motivated and able to work with multiple teams simultaneously.
· Must be able to travel locally up to 75% of the time
RCM Health Care ServicesRCM Health Care Services’ mission is to provide opportunities for qualified candidates across medical professions. We deliver timely results and have built a reputation of trust with our clients and candidates. Since 1975, we have been providing staffing solutions to many of the finest healthcare institutions across the nation and careers for thousands of candidates. As professional career opportunity matchmakers, we follow up and follow through to help our clients and candidates to reach their career and life goals. We proudly hold the Joint Commission Gold Seal of Approval as well.