AVP Quality Management - Plan
Job ID 2013-24247 # Positions 1
Search Category Nursing
Type Regular Full-Time (30 hours) Posted Date 9/23/2013
Additional Locations ..
More information about this job:
: Collaborates with other leadership team members to drive the development, coordination, communication and implementation of a strategic clinical quality management and improvement program within their assigned health plan. This may include, but is not limited to HEDIS reporting, member/provider satisfaction surveying and analysis, complaint and appeals processing, and QM internal and state scorecard reporting. Provides direction, leadership and education for compliance with NCQA standards to achieve and maintain NCQA accreditation, and may act as a QM liaison with state and federal regulatory agencies. Supports health plan coordination of the quality management program and business strategy by sharing replicable technology, benchmarking, and best practices. Works to establish and promote a culture of quality improvement and organizational excellence.
: 1. Directs and provides leadership for implementing, monitoring and evaluating the Quality Management Program for the health plan ensuring the needs of the population served, and all regulatory and accrediting requirements, are consistently met. 2. Promotes plan-wide understanding, communication, and coordination of the quality management program. 3. Directs and provides leadership for Plan compliance with NCQA standards; serves as the multi-departmental coordinator of the MBU-based NCQA workbook document as part of radiness reviews. 4. Provides leadership for the interpretation of results and development of improvement action plans arising from provider and member satisfaction surveys, inclusive of root cause analysis and action plans for improvement. . 5. Serves as a resource for design, monitoring and evaluations of Process Improvement Plans/Quality Improvement Plans and ensure they meet CQI methodology and state contractual requirements. 6. Provides leadership and ensure collaboration with other MBU quality leaders in developing, monitoring, and evaluating HEDIS improvement action plans inclusive of HEDIS strategy, year round medical record review, and over read processes. . 7. Monitors and reports quality measures per state, CMS and accrediting requirements. 8. Coordinates with MBU delegation team to ensure delegated services meet state CMS and accrediting requirements. . 9. Participates in the development and management of QM department annual operating and capital budgets to sufficiently meet departmental needs, and ensures the department stays within budget, and accounts for variances. 10. Selects, trains, develop and manage quality team members. 11. Performs other duties as assigned.
EDUCATION AND EXPERIENCE
: Education Required:
- Bachelor’s Degree in health or business related field Preferred:
- Advanced degree in health or business related field Years and Type of Experience Required:
- 10 years experience in a healthcare environment which includes previous leadership of specific CQM initiatives and programs; - Demonstrated expertise in end-to-end program leadership and strong general knowledge in all major CQM principals and programs - Five years leadership/management experience - Any combination of education & experience which provides and equivalent background may be considered Preferred: - CQM experience in a Managed Care organization strongly preferred - Previous NCQA survey experience - Previous supervisory experience of management level roles ADDITIONAL POPULATION/MARKET SPECIFIC EXPERIENCE REQUIREMENTS MAY APPLY. Certifications or Licensures Required:
Preferred: Current clinical license strongly preferred. Candidates without may only be considered where direct or 1-over reporting relationship to a clinician is feasible. Language Skills Required:
- English Preferred: - Functional Competencies: - 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 SCOPE INFORMATION # Direct Reports: # Indirect Reports: Budgetary $ Responsibility: PHYSICAL REQUIREMENTS
: 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