The MAHQ offers free job posting for active members who have a vacancy in their organization. Other interested parties can contact Anne Luco, MAHQ President at http://email@example.com for information related to job opportunity postings.
Current Job Opportunities: 2 Listing(s)
Posted April 12, 2018
Director of Quality
The Director of Quality is responsible for the strategic development of UMMSHP’s Quality
Improvement Programs. In collaboration with and under the direction of the Chief Medical Officer
this position provides ongoing maintenance and evaluation of quality systems with a focus on
quality of care/service, quality improvement assessments (QIAs), HEDIS, NCQA, delegation
oversight, and State regulatory EQRO compliance.
Essential Duties and Responsibilities:
- Maximize UMMSHP’s quality programs, in detail, so the strategies of performance measurement and public reporting are met. Drive the following quality of care critical needs for the health plan:
- Safety by avoiding injuries to members from the care that is intended to help them
- Effective services based on scientific knowledge to all who could benefit and refrain from providing services to those not likely to benefit (avoiding underuse and overuse, respectively)
- Member-centric care that is respectful and responsive to individual member preferences, needs, and values
- Reducing waits and sometimes harmful delays for both those who receive and those who give care
- Avoid waste, including waste of equipment, supplies, ideas, and energy
- Providing care that does not vary in quality because of personal characteristics such as gender, ethnicity, geographic location, and socio-economic status
- Identify options for redesigning performance measures, member/provider incentives, and performance improvement programs in ways that would encourage and reward improvements in health and health care delivery.
- Establishes quality improvement objectives; develops and implements the comprehensive Quality Management Program to meet the demographic and epidemiological needs of the population served and provide high quality and culturally appropriate care.
- Promotes plan-wide understanding, communication, and coordination of QM programs through established quality committee structure, creating targeted workgroups and ensure the stated goals and objectives are met.
- Maintain and establish 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.
- 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. Ensures necessary steps are taken to achieve a successful year over year improvement of HEDIS measures.
- Responsible for the reports and analysis of member care quality and for the development of plans and programs to support continuous quality improvement using HEDIS, CAHPS, Provider Satisfaction Surveys, and other tools.
- Responsible for ensuring compliance and providing direction and guidance on clinical quality improvement and management programs including National Committee for Quality Assurance (NCQA), URAC, or general accreditation.
- 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. Serve as a resource and leader working with research staff in study design, data collection, analysis, and reporting activities that support quality improvement interventions, transparency, compliance regulatory standards, and provider performance monitoring. Serves as resource for internal and external customers including Medical Directors, network providers, FQHCs, and provider organizations.
- Oversees internal and state QM Scorecard reporting including analyzing validity of Clinical Quality management data/reports from a clinical perspective.
- Represents Quality department by participating in assigned committees and interdisciplinary workgroups.
- Selects, manages, and develops new and existing departmental staff and ensures a healthy working environment. Maintains highly effective staff by developing, and training employees, communicating job expectations and monitoring job results. Offers counseling and coaching for new and existing employees.
- Ensures departmental compliance with health plan policies and procedures, including the annual updates and the development of new quality department policies, as needed,
- Responsible for oversight of the strategic operations of Quality Management department, it’s staff, and related departmental activities. Ensures an effective process for reporting information to support provider recredentialing, medical record reviews, and other performance and quality of care indicators.
- Maintains audit readiness, by ongoing training, competency assessment, audit, monitoring of metrics and corrective action through the complete accuracy of the Quality Improvement Work Plan and Quality Committee ongoing open action items
- Represents UMMSP’s interests by serving as the 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
- Annually, ensures compliance with federal, state, and accreditation standards by developing, implementing and maintaining compliance processes within the department and through out the health plan
- Supports the health plans’ External Quality Review Organization (EQRO) reporting and state audit processes.
- Develops and manages annual operating and capital budget to sufficiently meet departmental needs and ensure the best utilization of resources in collaboration with the Chief Medical Officer and Chief Financial Officer
Education, Experience and Qualifications:
- Active Maryland Nursing License
- 10 years of Experience in a healthcare environment which includes significant leadership roles and previous accountability for broad CQM initiatives.
- 6 years of leadership/management of others to include team leadership and supervision of management level roles
- 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
- Any combination of education &; experience, which provides an equivalent background, may be considered
- Possess a valid Maryland State driver’s license
- Must be able to travel as needed
- Continuous Quality Management (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.
- Certified Professional in Healthcare Quality (CPHQ)
Knowledge, Skills and Abilities:
- Demonstrate strength in strategic and analytical thinking, problem solving, communication (written and verbal), and presentation skills.
- Ability to engage and motivate staff toward success and the achievement of individual and health plan goals
- Extensive working knowledge of NCQA accreditation, state, and CMS regulatory requirements for Medicaid, Dual Eligible, Medicare SNP, CCIP, and Medicare STARS.
- Annual and ongoing production of sound analytic quality data to support HEDIS improvements and Quality Improvement Activities (QIAs)
- Demonstrates leadership for the member/provider satisfaction survey process, inclusive of root cause analysis and multifunctional action plans for improvement
- Provides operational leadership and quality-related business strategy for all aspects of the Quality program.
- Quality Management representation in new business activities, RFP responses, new market/product development, and state contract changes, etc.
- Provides leadership to ensure compliance with National Committee for Quality Assurance (NCQA) standards, or other accrediting bodies such as AHRQ, AHQA, NQF, URAC and AAAHC
- Collaborate with managed care industry-wide quality leaders to ensure appropriate communication, integration and utilization of managed care best practices
- Ability to present data and create reports to staff, peers, network providers and committees. Condenses complex information into a clear and precise clinical picture
- Pro-actively and consistently apply the regulatory and accreditation standards to assure that activities are reviewed and processed within guidelines.
- Reports audit or clinical findings to appropriate staff or others in order to ensure appropriate outcome and/or follow-up for improvement as indicated.
- Microsoft Office skills to include Word, Excel, Access, PowerPoint, Project and SharePoint
- Familiar with data entry systems (e.g., electronic medical records/electronic health records)
- Ability to learn new information systems and software programs
Posted April 9, 2018
ALLIANCE OF COMMUNITY HEALTH PLANS
POSITION: Senior Manager, Quality Programs
REPORTS TO: Chief Medical Officer
LOCATION: Washington, D.C.
The Alliance of Community Health Plans (ACHP) is a leadership organization that brings together
innovative non-profit health plans and provider organizations that are among America’s best at delivering
affordable, high-quality coverage and care to their communities. ACHP member organizations provide
coverage and care for more than 20 million Americans. Drawing on years of experience, member
organizations collaborate to identify problems, share information and work toward solutions to some of
health care’s biggest challenges. Their work is the foundation for ACHP’s advocacy on behalf of better
health care nationally. More information is available at www.achp.org
The Senior Manager of Quality Programs guides ACHP’s clinical performance improvement strategy that
drives member organizations’ understanding of the care they provide for their communities. This
individual researches and designs innovation programs for quality improvement and care management,
strongly supported by quantitative analysis. The analysis and insights allow ACHP member plans to
clearly understand and communicate the value of the care they provide and stay among the top rated
health plans in the nation. The senior manager is a self-starter who collaborates closely with health plan
clinical executives and quality leaders to develop learning programs around quality performance in all
lines of business. The senior manager also builds strong relationships with health care quality
stakeholders and organizations such as NCQA, positioning ACHP as a thought leader on quality
measurement and performance. Successful candidates will employ a knowledge of quality measurement
and health plan operations, experience with making meaning out of data, as well as an ability to facilitate
adult learning environments.
This individual should be passionate about high-quality, affordable care and be an idea-generator who
can help ACHP and its members further these goals. The senior manager position reports to the Chief
Medical Officer and is a key member of the Clinical Innovation team. We are a small organization and
place a high priority on enthusiastic team members who are eager to grow.
CORE DUTIES AND RESPONSIBILITIES
- Use knowledge of plan and provider operations in combination with data analyses to develop learning and innovation programs for quality leaders and clinical executives to improve ACHP health plan performance.
- Work collaboratively to develop presentations that clearly and concisely convey quality improvement opportunities and insights for key internal and external audiences.
- Assist ACHP’s integrated Advocacy team in communicating quality performance to policymakers, thought leaders and journalists, advancing perspectives on public reporting and quality rating systems.
- Build close relationships with ACHP members through ongoing engagement with senior health plan leaders to identify critical issues affecting performance.
- Manage member work groups in the areas of CMS MA Star Ratings, NCQA Accreditation and HEDIS reporting, clinical analytics as well as newly identified clinically-oriented topics of interest.
- Serve as a proactive liaison to the health care measurement community, including NCQA, PQA, and NQF, to foster meaningful engagement on behalf of ACHP health plans
- Contribute as a key writer for ACHP’s internal and external reports on clinical programs and innovations (e.g., PCORI research report)
- Develop innovative thinking and ideas around the future of quality measurement.
PROFESSIONAL EXPERIENCE, EDUCATION AND OTHER QUALIFICATIONS
- Bachelor’s degree required; Graduate degree in health-related field strongly preferred. Clinical background and experience a plus.
- 7+ years of relevant work and leadership experience with deep knowledge and experience with health plan quality ratings and measurement, including HEDIS, CAHPS and CMS Medicare Advantage Star Ratings.
- Understanding of health plan clinical operations; experience working at a health plan a plus.
- Strong writing skills; experience with grant writing or management a plus.
- Ability to make the connections between health care policy and real-world business dynamics.
- Excellent judgment and critical thinking skills.
- Confident and friendly verbal communication with a customer-focused mindset.
- Project management skills and demonstrated attention to detail with strong organizational abilities.
Please submit a resume and cover letter via e-mail to ACHP Human Resources at firstname.lastname@example.org
cover letter must include your salary requirements. Please include Senior Manager, Quality Programs,
along with your first initial and last name in the subject line of your e-mail message.
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