Manager, Quality Improvement

3 weeks ago

French Camp, United States SAN JOAQUIN COUNTY HEALTH COMMISSION Full time

**Remote position; must reside in California.**

**What You Will Be Doing**:
Under general supervision, the **Manager of Quality Improvement** is responsible for developing and implementing department business plans and overseeing resources and department operations in a manner that ensures regulatory and accreditation compliance and meets best practices. Work is varied and moderately complex and requires a moderate degree of discretion and independent judgement.

**Our Vision**:
Continuously improve the health of our community.

**Our Mission**:
We provide healthcare value and advance wellness through community partnerships.

**Essential Functions**:

- Develops unit goals based on established objectives, participating with peers to ensure effective integration; develops and implements associated action plans.
- Plans and assigns work; makes timely and effective adjustments as required.
- Monitors and analyzes metrics, including but not limited to regulatory activities, clinical and practitioner data; makes recommendations and implements action plans based on findings.
- Works to develop internal programs geared at continuous tracking, and trending of quality issues.
- Anticipates the need for and develops and implements relevant and effective programs, policies, procedures, and processes for the core quality program based on regulatory requirements, opportunities, issues, and trends.
- Collaborates with medical management and other departments to ensure that the Quality program meets or exceeds NCQA and regulatory standards.
- Collaborates with internal and external stakeholders to develop programs that increase awareness and provide educational opportunities to providers and members regarding HPSJ/MVHP’s Quality Improvement program goals and activities.
- Collaborates with the HEDIS team, Provider Services, and other internal and external stakeholders to ensure effective implementation of provider and member interventions to improve quality and HEDIS measures.
- Conducts the preparation, implementation, and corrective action plans for internal and external audit activities to ensure practices adhere to NCQA and regulatory standards of both DHCS & DMHC and CMS.
- Works closely with the network providers to improve the quality of care and service provided to the members, with a focus on improving MCAS performance and with appropriate submission of encounter data.
- Develops or oversees the development of relevant, timely and accurate internal and external quality reports, advising leadership as appropriate.
- Develops, implements, and maintains appropriate and required records, documents, policies, and procedures; collaborates with internal and external stakeholders to ensure the collection, storage and retrieval of relevant data and information.
- Participates in internal and external committees as required.
- Promotes and maintains and ensures that direct reports promote and maintain an environment that supports HPSJ’s strategy, vision, mission, and values.
- Hires, develops, and retains, and ensures that subordinate managers hire, develop, and retain competent staff.
- Oversees or conducts root-cause analysis investigations for specific patient care and network provider trends and all adverse effects; makes recommendations and implements action plans based on findings.
- Performs and oversees Facility Site Reviews and Medical Record Reviews.
- Assists in the development of department budget; manages budget for area of responsibility.
- Compiles, develops, and submits or oversees the compilation, development, and submission of internal and external quality reports.
- Proactively assists the department to prepare and build programs to monitor and address health disparities as they relate to the Quality Programs and Interventions to comply with regulatory & NCQA standards.
- Promotes and maintains and ensures that direct reports promote and maintain an environment that supports HPSJ’s strategies, vision, mission, and values.
- Hires, develops, supervises, and retains an adequate and competent staff.

**What You Bring**:
**Knowledge, Skills, Abilities and Competencies**

Required
- Strong clinical skills.
- In-depth knowledge of federal and state laws, standards, and regulations, including DMHC, DHCS, Medi-Cal and/or Medicare and HIPAA, as they related to quality in managed care organizations.
- In-depth knowledge of the principles and best practices of quality improvement, including but not limited to metrics and corrective action plans.
- In-depth knowledge of the healthcare issues affecting the underserved.
- Basic knowledge of the business, economic, demographic, and political trends and developments affecting managed care, Medi-Cal and/or Medicaid.
- In-depth knowledge of audit processes, including state audit processes, and ability to effectively implement and maintain them.
- Financial acumen: Interprets and applies understanding of key financial indicators to make better business decisions.
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