VP Quality Management - Plan Wisconsin
Job ID 2013-23807 # Positions 1
Search Category Quality
Type Regular Full-Time (30 hours) Posted Date 10/8/2013
Additional Locations ..
More information about this job:
This position is responsible, for developing, coordinating, communicating and implementing a strategic clinical quality management and improvement program within their assigned health plan. This includes establishing indicators for monitoring and evaluating the quality and appropriateness of care/service, assessing for continuous improvement in monitored indicator activities, monitoring member satisfaction, and directing initiatives for improvement and evaluating the effectiveness of interventions across the continuum of care to members. Represent organizational interests by serving as a liaison for clinical quality initiatives with state/federal regulatory agencies, and collaborates with regulatory, compliance, and government relations leaders to meet external quality information needs. Provides operational leadership and quality-related business strategy for all aspects of the QM program within the Plan. Collaborates with enterprise-wide quality leaders to ensure appropriate communication, integration and utilization of best practices in all areas.
1. Promotes broad understanding, communication, and collaboration with enterprise-wide quality leaders to ensure appropriate communication, integration and utilization of best practices in all areas.
2. Oversees internal and state QM Scorecard reporting including analyzing validity of Clinical Quality management data/reports from a clinical perspective.
3. May provide oversight for the member complaint, appeal processes, privacy compliance processes, or auditing of delegated services in assigned area.
4. Demonstrates leadership for the member/provider satisfaction survey process, inclusive of root cause analysis and multifunctional action plans for improvement.
5. Provides oversight for Health Employer Data Information Sets (HEDIS) reporting and provides leadership to the development and realization of action plans to achieve target improvement goals.
6. Supports the health plans’ External Quality Review Organization (EQRO) reporting and state audit processes.
7. Provides leadership for QM representation in new business activities (RFP responses, new market/product development, and state contract changes etc.)
8. Provides leadership to ensure compliance with National Committee for Quality Assurance (NCQA) standards, or other accrediting bodies such as URAC and AAAHC.
9. Ensures an effective process for reporting information to support provider recrednetialing, medical record reviews, and other performance and quality of care indicators.
10. Develops and manages annual operating and capital budget to sufficiently meet departmental needs and ensure the best utilization of resources.
11. Selects, manages, and develops new and existing departmental staff and ensures a healthy working environment.
12. Performs other duties as assigned.
EDUCATION AND EXPERIENCE
- Bachelor’s Degree in health or business related field.
- Advanced degree in health or business related field.
Years and Type of Experience Required:
- 10 years of Experience in a healthcare environment which includes significant leadership roles and previous accountability for broad CQM initiatives.
- Demonstrated expertise in driving positive, strategic results related to NCQA, HEDIS, or Clinical Quality Performance Measurement and Improvement Programs.
- Strong qualitative and quantitative data analysis skills and experience.
- 6 years of leadership/management of others to include team leadership and supervision of management level roles.
- Any combination of education & experience which provides an equivalent background may be considered.
- CQM experience in a Managed Care Organization strongly preferred.
- Population health management and/or clinical quality program development experience strongly preferred.
- New market expansion experience.
ADDITIONAL POPULATION/MARKET SPECIFIC EXPERIENCE REQUIREMENTS MAY APPLY.
Certifications or Licensures
- Current clinical license strongly preferred. Candidates without may only be considered where direct or 1-over reporting relationship to a clinician is feasible.
- Proficient in the use of Microsoft Office products, to include Outlook, Word, Excel and PowerPoint.
- Excellent problem solving skills; ability to multi-task and solve complex problems.
- Excellent organizational and analytical skills.
The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Must be able to operate general office equipment including but not limited to: computer, phones and related media and information devices.
- Ability to communicate both in person and/or by telephone.
- Must be able to travel as needed and adhere to Amerigroup travel policies and procedures.