JOB SUMMARY: The Manager of Quality Management is responsible in conjunction with the plan QM leader, the Plan Medical Director and CEO for developing, coordinating, and implementing quality initiatives within the health plan.

Provides clinical and technical supervision to a team responsible for monitoring and evaluation the quality of care/service, appropriateness, continuous improvement, member satisfaction, and results of actions across the continuum of care to members.

Assist in coordinating the quality management program activities throughout the functional areas of the health plan.

PRIMARY RESPONSIBILITIES

1. Assists in establishing objectives and annual goals in conjunction with the plan QM leader, the Plan Medical Director and CEO[^%dot%^

2. In conjunction with the plan QM leader, implements the comprehensive Quality Management Program to meet the demographic and epidemiological needs of the population served.

3. Promotes plan-wide understanding, communication, and coordination of the quality management program.

4. Manages and evaluates team's performance and ensure adherence to department's standards.

5. Trends quality data and develops aggregate and individual plan reports as indicated.

Analyzes validity of data/reports.

6. Coordinates on a quarterly basis reporting of all quality/risk initiatives to all appropriate committees.

7. Develops, designs, implements and evaluates activities including coordination of focus studies and other indicators of quality of care/service.

8. Coordinates development, implementation, and evaluation of continuous quality improvement action plans for the improvement activities.

9. Participates in the reporting of the Health Employer Data Information Sets (HEDIS) data and coordinates the improvement action plans.

10. Coordinates the state regulatory quality reporting for the health plan.

11. Provides support for provider recredentialing in the areas of medical record reviews, quality indicators and trended data.

12. Assures compliance with State and Federal quality improvement requirements.

Prepares plan staff for successful State and internal audits.

13. Maintains liaison for quality initiatives with State and Federal regulatory agencies as needed.

14. Evaluates and makes recommendations for oversight of delegated services.

15. Assists in developing the annual operating and capital budgets to sufficiently meet departmental needs and ensures that department stays within budget and accounts for variances.

16. Interviews, manages, evaluates, and develops new and existing departmental staff.

17. Recognizes and utilizes appropriate channels for communication and encourages two-way communication and encourages staff to participate in creative program development.

18. Work collaboratively with key health care professionals toward identification of opportunities for improvement, trend analysis, education and development of appropriate action plans for problem resolution.

19. Effectively communicates information to superiors, team members, and other appropriate staff in a timely, accurate, and courteous manner.

20. Actively participates in meetings and helps maintain an effective work group.

21. Develops presentations on activities for a variety of audiences as needed.

22. Other duties as requested or assigned.

EDUCATION AND EXPERIENCE: Education Required: * Associates Degree Education Preferred: * Bachelors Degree, or MSN, MPH, MPA Years and Type of Experience Required: * Minimum of 5 years of current experience in quality improvement, and/or utilization review in HMO setting with at least 1 year management/leadership experience.

Years and Type of Experience Preferred: * Previous NCQA accreditation and HEDIS reporting experience preferred * Experience with the urban Medicaid population preferred Certifications or Licensure Required: * Current state RN license Certification or Licensure Preferred: * Risk Management License preferred; CPHQ preferred.

Other Required: * Strong knowledge base in areas of quality improvement.

* Excellent written and verbal communication skills.

* Ability to work effectively with physicians and other health care providers as well as with multi-disciplinary teams across department lines.

* Excellent problem solving skills * Demonstrates strong organizational skills.

* Knowledge of basic computers including word processing and spreadsheets.

* Ability to work in a team environment.

* Ability to develop and give presentations.

* Ability to handle multiple tasks.

* Appreciation of cultural diversity and sensitivity towards target population PHYSICAL REQUIREMENTS * Must be able to operate a computer.

* Must be able to operate a telephone In accordance with state and federal laws, employment offers are tendered solely on the basis of qualifications without regard to race, religion, color, national origin, age, sex, marital status, sexual orientation, handicap (including disabled veterans) or Vietnam Era veteran status.

AMERIGROUP administers pre-employment drug testing as a condition of employment and a satisfactory criminal history background report.

To Apply for this position, please CLICK HERE

« Apply for Manager of Quality Management RN Job in Hanover 21075, Maryland US