Manager Clinical Quality
Phoenix, AZ – Employee, Full-Time, Flexible Schedule
Manager Clinical Quality
Phoenix, AZ (835078)
For those who want to invent the future of health care, here’s your opportunity. We’re going beyond basic care to health programs integrated across the entire continuum of care. Join us and help people live healthier lives while doing your life’s best work.(sm)
This position requires an experienced mid-market individual familiar with the general operations of a Medicaid and / or a Medicare plan, and some familiarity with quality management within a Medicaid / Medicare market. This position will be responsible for management of professional staff. The success of the quality program also depends upon community based resources and the ability to professionally communicate, influence and build relationships with personnel representing those community organizations.
In addition to leadership skills, a strong comfort with managing quality improvement initiatives is needed. This includes leading quality improvement teams as well as assessing the efficacy of quality improvement interventions.
This position may be responsible for reporting and analysis of quality performance measures, oversight of audits related to regulatory contractual requirements, development of plans and programs to support continuous quality improvement using HEDIS measures and other tools and creation and submission of annual and quarterly submissions to different state regulators.
If you are located in the Phoenix area with the ability to travel throughout the state as needed, you will have the flexibility to telecommute* 3 days per week as you take on some tough challenges.
Team Management: Manage staff within the quality management department, including employees responsible for data analytics
Quality Improvement Projects: lead teams responsible for implementing provider- and member-focused interventions to meet Medicaid and Medicare quality performance goals
Annual Regulatory Reporting: Responsible for design, implementation and approval of quality improvement programs and work plans, as well as development and approval of annual quality program evaluations
Quality Improvement Design: Responsible for selection and design of new improvement projects based upon analyses, literature review and other quality reviews to improve member care
Quality Improvement Interventions: Responsible for maintaining or improving performance upon contractual and nationally required quality performance metrics, including HEDIS and customized state measures
Audits: Oversee quality audits to ensure appropriate collection, tracking and reporting upon medical records required for focused quality improvement studies or regulatory audits
Liaison with community based organizations: coordinate with appropriate agencies and programs to assist with connecting members with these organizations, increase member utilization of community-based organization services, including WIC, Head Start and home visiting programs
RN or Bachelor’s level degree or higher with CPHQ Certification or ability to obtain within six months
4+ years working in managed care quality department in Medicaid/Medicare or equivalent experience in non-managed care setting
2+ years in a Manager or Supervisory position
Proficiency in software applications that include, but are not limited to, Microsoft Word, Microsoft Excel, Microsoft PowerPoint
Proven success managing and implementing quality improvement programs
Demonstrated ability to assist with focusing activities toward a strategic direction as well as develop tactical plans and drive performance
Demonstrated problem solving skills with the ability to systematically analyze problems, draw relevant conclusions and devise appropriate courses of action
Experience analyzing and presenting complex information to key stakeholders verbally and in wr…
Medical & Health , Nursing , Operations
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