See more Collapse

Director of Quality Health Integration

2 months ago

Menasha, United States Network Health Full time

Network Health's success is rooted in its mission to create healthy and strong Wisconsin communities. It drives the decisions we make, including the people we choose to join our growing team. Network Health is seeking a Director of Quality Health Integration. This individual is responsible for Responsible for maintaining clinical quality standards compliant with NCQA and other regulatory agencies. Responsibilities include ongoing improvement initiatives necessary for regulatory and accreditation compliance and working toward the improvement of member health status. Responsible for the establishment, maintenance, and coordination of condition management and appeals and grievance programs in compliance with NCQA quality standards, CMS Stars and other regulatory agencies. Works in conjunction with Vice President Quality and Clinical Integration, CMO, and other leadership for improvements and to implement changes that will have a positive impact on service to internal and external customers. Job Responsibilities: Oversees the complaints, appeals and grievance program for Network Health, including policies, procedures, processes, and reporting to analyze, evaluate, and improve the quality and efficiency of processes and outcomes. Works collaboratively with Network Health departments and committees to develop criteria, service and quality indicators, tracking mechanisms, reports, standards of care that facilitate Quality Improvement initiatives, and outcomes. Maintains ongoing communication with Network Health departments for the purpose of integrating, coordinating and monitoring the effectiveness of Quality Improvement activities for Commercial and Government products. Supervises the identification of quality improvement needs and design of valid and reliable tools for data collection, analyzes data, and provides feedback in an appropriate format. May assist with implementation of quality initiatives. Monitors outcomes and quality of services provided. Uses statistical methods in data collection, sampling and analysis. Collaborates with Network Health departments to execute against various Quality Improvement initiatives as required for NCQA, CMS and other regulatory bodies. Supervises in the development of communication to practitioners and members, and the coordination of those communications. Collaborate with Government Program, Risk Adjustment, and other departments to design shared initiatives around member and provider incentives, retention, satisfaction, interoperability, and gap closure programs. Collaborates with the VP of Quality and Clinical Integration on preparing, and monitoring budget for the areas of responsibility. Responsible for oversight of all regulatory required committees related to quality. Presents and/or participates on Network Health committees including QMC, executive council, and others as assigned. Works in conjunction with the VP of Quality and Clinical Integration and other QHI leaders for performance in: NCQA ratings, accreditation surveys; CMS Star Ratings and QRS Ratings; OCI, Peer Review and Quality of Care programs and other government regulatory agency standards relating to quality. Oversee condition management programs to manage Network Health low and medium risk members who may benefit from self-management and coaching and use data to perform outreach with goal of increasing members' abilities to manage their chronic and acute health conditions and decrease unnecessary utilization and quality gap closure. Assists Network Health Management in designing goals, action plans, and strategies to support the Quality Improvement processes. Reviews and manages contracts for HEDIS, CAHPS, HOS and MRA vendors as well as other vendors as assigned. Performs other duties as assigned. Job Requirements: Bachelor of Science in Nursing or other related health care field required. 3 years of experience in quality program process and development required. 7 years working in the health care industry. 3 years of related leadership experience required. Deep experience with HEDIS, CMS Stars, and NCQA accreditation required. Network Health is an Equal Opportunity Employer. We encourage applications from all backgrounds, communities and industries, and are committed to having a team that is made up of diverse skills, experiences and abilities. We are committed to equality and diversity within Network Health. Helping diverse candidates find great careers is our goal. The information you provide here is secure and confidential. We are now directing you to the original job posting. Please apply directly for this job at the employer’s website.

#J-18808-Ljbffr

We have other current jobs related to this field that you can find below

  • Associate Director of Brand and Design

    4 weeks ago

    Menasha, United States United Way Full time

    Job Description Job Title:Associate Director of Brand and Design Department: Marketing and Communications Reports to:President/CEO Status: Full-Time FLSA Classification: Exempt Date:July 22, 2024 Mission: United Way Fox Cities (UWFC) improves lives by bringing diverse people together to build a stronger, more caring community for everyone. Core...

  • Behavioral Health RN

    4 weeks ago

    Menasha, United States ThedaCare Full time

    Why ThedaCare? Living A Life Inspired! Our new vision at ThedaCare is bold, ambitious, and ignited by a shared passion to provide outstanding care. We are inspired to reinvent health care by becoming a proactive partner in health, enriching the lives of all and creating value in everything we do. Each of us are called to take action in delivering higher...

  • Assistant Health Safety

    4 weeks ago

    Menasha, United States TC Transcontinental Full time

    Health, Safety, & Environmental (HSE) Manager Create value at TC TranscontinentalAt TC Transcontinental, we've got it made, and that's because of the expertise of our team. We are currently looking for a Health Safety & Environmental Manager for our Menasha, WI location. The HSE Manager will assist the Sr. HSE Manager in overseeing all facets of health and...

  • Dentist / Community Health

    2 weeks ago

    Menasha, United States RLJ Dental Full time

    div>General Dentist RLJ Dental is looking for a General Dentist to join our team. Why Heartland Dental? As the leader of your supported office, you’ll receive best in class support to provide exceptional lifetime patient care while experiencing unparalleled educational offerings to enhance your elite clinical skills. You’ll work in an environment that...

  • Summer Day Camp Counselor

    3 months ago

    Menasha, United States KE Camps Full time

    KE Camps is the leading provider of summer camps for country clubs nationwide. We partner with over 230 private clubs all over the country to implement traditional-style day camps for elementary-aged children. Our Staff are the backbone of our programs and therefore, we pride ourselves on giving them an incredible amount of support. As a staff member, we...

  • Registered Dietitian

    1 month ago

    Menasha, United States Sharecare Full time

    Job Description:Sharecare is the leading digital health company that helps people - no matter where they are in their health journey - unify and manage all their health in one place. Our comprehensive and data-driven virtual health platform is designed to help people, providers, employers, health plans, government organizations, and communities optimize...

  • Physical Therapist

    3 months ago

    Menasha, United States CTTX Health Full time

    Job DescriptionJob DescriptionCTTX Health is a leading healthcare company specializing in providing top-quality physical therapy services. We are currently seeking dedicated and passionate Physical Therapists (PTs) for travel positions throughout the country.As a Physical Therapist Traveler at CTTX Health, you will have the opportunity to work in various...

  • Engineering Director

    3 months ago

    Menasha, United States FTI Full time

    A position at FTI can be the answer to your future career. In this role, you’ll be part of a progressive national leader in electrical planning, engineering, technology and energy services. FTI enables employee growth and success through industry-leading training and development, utilization of the latest industry technologies, and an uncompromised focus...

  • Registered Dietitian

    1 month ago

    Menasha, United States Sharecare Full time

    Job Description: Sharecare is the leading digital health company that helps people - no matter where they are in their health journey - unify and manage all their health in one place. Our comprehensive and data-driven virtual health platform is designed to help people, providers, employers, health plans, government organizations, and communities optimize...

  • BI (SQL) Developer - Data Warehouse

    3 months ago

    Menasha, United States Network Health Full time

    Description Network Health's success is rooted in its mission to create healthy and strong Wisconsin communities. It drives the decisions we make, including the people we choose to join our growing team. Network Health is seeking a SQL Developer - Data warehouse This individual is part of a team dedicated to supporting Network Health's Enterprise Data...

  • Child Care Teacher

    3 months ago

    Menasha, United States The Salvation Army Full time

    Job Description The Salvation Army of Fox Cities helps support it’s community in many ways. We help feed our community as well as help those in need overcome poverty and addition. Not only that, we help provide for the youth within our community. The Children's Learning Center is a licensed day care in the state of Wisconsin for children ages 6...

  • Associate BI Developer

    1 week ago

    Menasha, United States Network Health Plan (Wisconsin) Full time

    Network Health’s success is rooted in its mission to create healthy and strong Wisconsin communities. It drives the decisions we make, including the people we choose to join our growing team. Network Health is seeking an Associate BI Developer. This individual is part of a team dedicated to supporting Network Health’s Enterprise Data Warehouse. This...

  • Weekends Only

    1 week ago

    Menasha, United States Interim HealthCare of the Fox Cities Full time

    Job DescriptionJob DescriptionDescription:Interim Healthcare is seeking to hire outstanding Caregivers to join our amazing care team providing in-home care services. We have immediate flexible full-time and part-time positions available. Make a difference in the life of a veteran, retired school teacher, or even a doctor! Learn about their stories and...

  • Weekends Only

    3 months ago

    Menasha, United States Interim HealthCare of the Fox Cities Full time

    Job DescriptionJob DescriptionDescription:Interim Healthcare is seeking to hire outstanding Caregivers to join our amazing care team providing in-home care services. We have immediate flexible full-time and part-time positions available. Make a difference in the life of a veteran, retired school teacher, or even a doctor! Learn about their stories and...

  • Private Duty In-Home Caregiver

    3 months ago

    Menasha, United States Interim HealthCare of the Fox Cities Full time

    Job DescriptionJob DescriptionDescription:Interim Healthcare is seeking to hire outstanding Caregivers to join our amazing care team providing in-home care services. We have immediate flexible full-time and part-time positions available. Make a difference in the life of a veteran, retired school teacher, or even a doctor! Learn about their stories and...

  • Private Duty In-Home Caregiver

    3 months ago

    Menasha, United States Interim HealthCare of the Fox Cities Full time

    Job DescriptionJob DescriptionDescription:Interim Healthcare is seeking to hire outstanding Caregivers to join our amazing care team providing in-home care services. We have immediate flexible full-time and part-time positions available. Make a difference in the life of a veteran, retired school teacher, or even a doctor! Learn about their stories and...

  • Private Duty In-Home Caregiver

    7 days ago

    Menasha, United States Interim HealthCare of the Fox Cities Full time

    Job DescriptionJob DescriptionDescription:Interim Healthcare is seeking to hire outstanding Caregivers to join our amazing care team providing in-home care services. We have immediate flexible full-time and part-time positions available. Make a difference in the life of a veteran, retired school teacher, or even a doctor! Learn about their stories and...

  • Private Duty In-Home Caregiver

    7 days ago

    Menasha, United States Interim HealthCare of the Fox Cities Full time

    Job DescriptionJob DescriptionDescription:Interim Healthcare is seeking to hire outstanding Caregivers to join our amazing care team providing in-home care services. We have immediate flexible full-time and part-time positions available. Make a difference in the life of a veteran, retired school teacher, or even a doctor! Learn about their stories and...

  • Private Duty In-Home Caregiver

    7 days ago

    Menasha, United States Interim HealthCare of the Fox Cities Full time

    Job DescriptionJob DescriptionDescription:Interim Healthcare is seeking to hire outstanding Caregivers to join our amazing care team providing in-home care services. We have immediate flexible full-time and part-time positions available. Make a difference in the life of a veteran, retired school teacher, or even a doctor! Learn about their stories and...

  • Private Duty In-Home Caregiver

    3 months ago

    Menasha, United States Interim HealthCare of the Fox Cities Full time

    Job DescriptionJob DescriptionDescription:Interim Healthcare is seeking to hire outstanding Caregivers to join our amazing care team providing in-home care services. We have immediate flexible full-time and part-time positions available. Make a difference in the life of a veteran, retired school teacher, or even a doctor! Learn about their stories and...