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Quality Assurance and Improvement Director
4 months ago
**Quality Assurance and Improvement Director**
- **Santa Maria Wisdom Center**_
DIVISION: Company wide
LOCATION: Santa Maria, CA
HIRING RATE: $85,000- $95,000/salary
**Responsibilities**
The Quality Assurance and Improvement (QIA) Director is responsible for managing staff training and the successful planning, implementation and management of quality activities and other related program obligations. The position provides support to all internal department leaders and the Executive Director. The QAI Director’s role is to serve as the key liaison in coordinating quality measures activities, projects and bridge other departments and health plans in the workflow to meet the performance standards and benchmark for all measures in the CalAIM and ADHC/CBAS programs.
The Quality Assurance and Improvement Director (QAID) ensures compliance with all relevant regulations and policies and the program meets the standards set by The Wisdom Center, CalAIM, DHCS and CenCal. The QAID is responsible for the successful planning, implementation and management of quality activities and other related program obligations. The QAID ensures accountability of staff by providing feedback to the staff through regular reporting, ensures that staff are held accountable for their actions, staff members are properly trained, and that policies and procedures are followed. The QAID also supports the efficiency of the program, helping to contain costs by identifying areas where the program can be more efficient, helping to ensure the long-term sustainability of the program.
**SPECIFIC DUTIES**
- Conducts audits of all CalAIM program’s documentation to ensure compliance with requirements and best practices.
- Work closely with CalAIM Program Directors and staff to monitor and evaluate the quality of services provided and accurate and timely completion of documentation. Provide feedback to directors of findings.
- Develop and implement data collection and analysis plans to monitor and evaluate program performance and outcomes.
- Prepare requested reports on program performance and outcomes.
- Identify areas of improvement and implement strategies, in collaboration with CalAIM Program Directors, to improve service quality.
- Comply with company policies and procedures
- Model leadership behavior, support team with quality and production goals through coaching, feedback, and development of reporting staff
- Provide feedback to Program Directors related to workloads and assignments of individuals on their teams
- Support the providers in preparing infrastructure for quality management implementation through activities such as advising on proper documentation, billing, and coding, pre-screening appointments, and helping to improve Medicaid/CenCal Health HEDIS scores, therefore supporting improved health in our membership
- Attend relevant Health Plan and other trainings’
- Manage Reporting - generate and maintain accurate weekly and monthly report of QAID and CalAIM activities
- Track and report savings results from improvements
- Lead and develop training programs and materials for all CalAIM Programs
- Support tracking of provider documents including formal letters, faxes, certified mail and drafting of these documents as needed.
- Performs other duties, projects and actions as assigned in a professional manner, utilizing time and resources efficiently
**ACCOUNTABILITY AND REVIEW**
Position Reports To: Director of CalAIM Programs
Performance Review: First Quarter (90 days) of employment, then Annual thereafter
**DIRECT REPORTS**
Number of employees receiving work direction: Zero (0)
Position titles reporting to position: Zero (0)
**Minimum Qualifications**
**KNOWLEDGE AND SKILLS**
- Working knowledge of managed care, health plan product lines (HMO, PPO, Medicare, Medi-Cal, etc.)
- Demonstrated ability to conduct and interpret quantitative/qualitative analysis
- Ability to coach and mentor staff and engage in difficult conversations
- Demonstrate an understanding of the operations of the program, health policy trends, and any applicable regulations related to the responsible technical area
- Ability to understand and explain data reports in diverse ways to staff, program directors and others
- Proven ability to prioritize and organize multi-faceted/multiple responsibilities simultaneously in a fast paced, changing environment while meeting deadlines and turnaround time requirements
- Must possess the ability to educate and train provider office staff members
- Must be able to work independently utilizing all resources available while staying within the boundaries of duties
- Ability to keep an elevated level of confidence and discretion when dealing with sensitive matters relating to providers, members, business plans, strategies and other sensitive information is required
- Excellent presentation, verbal and written communication skills, and ability to collaborate with co-workers, senior leadership, and other management
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