Manager, Quality Improvement

Job Description:

POSITION SUMMARY

The Manager, Quality Improvement is primarily responsible for the facilitation, execution, and coordination of all clinical quality improvement/management activities. The Manager helps to plan, develop, organize, communicate, and recommend modifications to the QI Program and all QI policies and procedures. This position will also be responsible for organizing and managing program accreditation activities.

GENERAL RESPONSIBILITIES

1. Develop and/or revise annually the QI program, evaluations, and work plan. Present for review and approval.
2. Develop quarterly QI activity progress report.
3. Develop and/or revise annually QI policies and procedures for appropriate business functions.
4. Oversee all QI processes, including but not limited to HEDIS and NCQA.
5. Lead, monitor and report to the Quality Improvement Committee on quality improvement activities in accordance with the QI program.
6. Interface with all internal departments and markets to ensure compliance to the QI program policies and procedures.
7. Serve as liaison between XLHealth and outside agencies for clinical QI activities.
8. Lead NCQA and/or URAC accreditation process.
9. Oversee clinical data collection, analysis, reporting and follow up for CMS and NCQA.
10. Identify compliance problems and formulate recommendations for corrective action.
11. Develop and present reports to internal management and the Quality Improvement Committee as needed.
12. Update all QI policies and procedures.
13. Provide formal CQI education to all XLHealth employees.
14. Supervise and evaluate QI personnel.

REQUIRED EDUCATION AND EXPERIENCE

1. Current Maryland R.N. license required.
2. Bachelors Degree in a healthcare related field preferred.

3. Minimum 3 years Quality Improvement experience in a managed care environment, preferably with Medicare and NCQA program involvement.
4. Minimum 2 years direct HEDIS audit experience required.
5. Minimum 1 years experience in healthcare management, preferably in managed care or disease management.
6. Minimum 3 years in a supervisory role required.

REQUIRED KNOWLEDGE, SKILLS, AND ABILITIES
1. Knowledge of Medicare, Medicaid, NCQA, HEDIS regulations and accreditation policies/guidelines.
2. Knowledge of State regulations (MD, TX, Ark, MO, SC, Ga) preferred
3. Proficiency with MS Office Suite.
4. Excellent communication skills.
5. Experience with creating and delivering presentations.
6. Able and willing to travel up to 20%.