Quality Management Manager

2 weeks ago

Robbinsville, United States AmeriHealth Caritas Full time
Job Description
Job Brief

Behavioral Health Quality Manager for PerformCare New Jersey. Master's level degree with added certification is required. Certified Professional in Health Quality (CPHQ) or Lean Six Sigma needed.







Your career starts now. We’re looking for the next generation of health care leaders.


At AmeriHealth Caritas, we’re passionate about helping people get care, stay well and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we’d like to hear from you.


Headquartered in Newtown Square, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services.


Discover more about us at www.amerihealthcaritas.com.


The Quality Management Manager is responsible for the measurement of clinical performance for the Children’s System of Care.  This position identifies opportunities for clinical performance improvement, develops quality improvement initiatives and provides recommendations to PerformCare and the Children System of Care.  This position monitors Perform Care’s adherence to state clinical and quality standards and manages policy development, quality of care, health equity as well as quality committee structure and support.


Job Duties Include: 


The Quality Management Manager contributes to the PerformCare New Jersey (PCNJ) quality improvements functions via Quality Interventions, Quality Improvement and Quality assurance. These activities may include interventions such as removing barriers to behavioral and health care, identify health disparities, review of potential quality of care concerns and review critical incidents, investigates reported complaints and grievances, review of electronic health record for the purpose of auditing and credentialing. 



  • Analyzes quality data from all sources and directs to appropriate committees and senior management.
  • Monitors and ensures that quality activities that involve clinical decision-making are completed on time and accurately and presents results and findings to senior management, and stakeholders. 
  • Writes narrative reports to interpret regulatory specifications, explain community services and share and document outcome findings, limitations, and possible interventions.
  •  Leads quality improvement activities, meetings, and discussions with departments within the organization.
  • Partners and collaborates with the State leaders and its counterparts.
  • Provides data collection and report development support for quality improvement studies and performance improvement projects. 
  • Participates in the planning, developing, and implementing PerformCare’s activities related to accreditation such as NCQA, and AOP-specific initiatives.
  • Maintains current knowledge of PCNJ’s policies and procedures and assists in clinical/quality policy enhancement and development.
  • Works collaboratively with behavioral health services to identify educational needs of staff and to maintain appropriate clinical expertise required to successfully perform daily responsibilities.  
  • Provides input into the development of educational material and programs necessary to meet system of care objectives, youth and family needs.

Education/ Experience: 



  • Master’s Degree from an accredited educational program in public health, health care administration Psychology, Nursing or Behavioral Clinical Specialty with a concentration in quality management required. 
  • LCSW/LCADC/LPC with a Active license in the state of New Jersey; or Registered Nurse (RN) with Behavioral/Mental Health experience with an Active RN license in the state of New Jersey preferred.
  • 5 years experience in a Behavioral Health Care setting.

Other Skills:



  • Minimum 5 years’ experience in healthcare with minimum 3 years’ experience in health plan quality improvement, managed care, or equivalent experience. 
  • Basic knowledge of NCQA preferred.
  • Certified Professional in Health Quality (CPHQ) preferred.
  • Knowledgable of Lean Six Sigma tools and frameworks preferred.
  • Knowledgable in the use of data analytics to identify and measure process improvement results preferred. 


  • This is a 100% remote position, and our preference is that candidates live within a 90 minute commute of Robbinsville, NJ. Qualified candidates from outside that geographic area will be considered.

Diversity, Equity, and Inclusion


At Amerihealth Caritas, everyone can feel valued, supported, and comfortable to be themselves. Our commitment to equity means that all associates have a fair opportunity to achieve their full potential. We put these principles into action every day by acting with integrity and respect. We stand together to speak out against injustice and to break down barriers to support a more inclusive and equitable workplace. Celebrating and embracing the diverse thoughts and perspectives that make up our workforce means our company is more vibrant, innovative, and better able to support the people and communities we serve.


We keep our associates happy so they can focus on keeping our members healthy.


Our Comprehensive Benefits Package


Flexible work solutions including remote options, hybrid work schedules, Competitive pay, Paid time off including holidays and volunteer events, Health insurance coverage for you and your dependents on Day 1, 401(k) Tuition reimbursement and more.


 



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