Quality Manager

3 weeks ago

Atlanta, United States Sonder Health Plans, Inc. Full time

Salary Range $80k to $120,000 annually.LocationHybrid - Atlanta, GAPrimary Responsibilities Actively researches and develops interventions that can be used to improve performance and clinical quality and support HEDIS, clinical measures and the accreditation process. Identifies, leads and facilitates performance improvement projects and initiatives, measurement and analysis for Medicare programs, processes, and outcomes. Develops and writes business cases and quality improvement plans, charters, and reports. Builds a dynamic culture of member safety by developing and leading clinical aspects of the Quality of Care (QOC) process. Engages with healthcare teams in the development and adoption of QI frameworks, performance improvement around nationally endorsed quality measures, strategy development that drives a culture of continuous quality improvement, by leveraging those relationships. Evaluates data needs and collaborates with other analytics teams to identify opportunities which support departmental and divisional goals. Assists others within the Quality Department in study design, planning for data collection, root cause analysis and implementing solutions. Performance and Improvement Initiatives: Conducts audits that supports regulatory and accreditation requirements, including audits of external vendors and delegates, internal processes, and clinical measures, such as HEDIS and Stars Serves as a subject matter expert consulting with external representatives including provider office staff and delegates. Develops major quality improvement activities and programs that encompass research, study design, population, and outcome analysis. Leads multidisciplinary efforts to develop population health programs and clinical guidelines designed to improve quality of care. Optimizes the use of existing information resources and develops additional resources. Reviews documentation for compliance; audits processes; interviews appropriate management, and staff; assists with gap analysis and the development and monitoring of corrective action plans. Serves as a resource to staff and delegates seeking to better understand the accreditation/regulatory agency standards and aids in the development of internal action plans to assist others in development of processes and protocols within their department. Annual Quality Review and Development of Work Plan: Participates in the annual update of quality improvement (QI) program description and QI work plan. Collaborates with Health Services partners in the development and revision of the annual Model of Care Assists with the evaluation of the effectiveness of the QI program and its related improvement projects, as well as identification of performance improvement opportunities. Report Development: Develops and writes performance improvement plans in accordance with regulatory and accreditation requirements. Reviews and edits documents which will be utilized with both internal and external audiences. Coordinates the Quality-of-Care process by reviewing weekly concurrent review reports and ensuring other QOC referrals are appropriately screened and processed. Facilitates the thorough investigation of potential QOC concerns and the Peer Review Committee alongside the medical director. Continues to develop and monitors "Track and Trend" database for effective reporting to appropriate committees. Serves as a SME on issues related to clinical quality and program development. Regularly appraises and updates relevant quality measures and benchmarks to align with Sonder Health Plans' overall strategy. Manages and collaborates with committees related to clinical quality, performance improvement, risk and accreditation requirements such as the Peer Review, Fraud Waste and Abuse, Credentialing, Risk and Delegated Oversight Committees Manages relevant workplans, agenda management, meeting minutes and follow-up items. Co-Chairs the Plan's Quality Improvement Committee (QIC) meetings quarterly, creates agenda, minutes, communicates with all department heads for their individual presentations and manages stipends / expenses for committee community physician consultants. Manages relationship and collaboration with the HEDIS vendor, HEDIS auditor and survey vendors. Responsible for Plans CCIP (Chronic Care Improvement Program) document, updates, and submission to CMS annuallyRequired Qualifications Registered Nurse with licensure in Georgia 5 years of previous clinical experience in primary care, specialty, or acute care setting Bachelor's Degree from a college or university in clinical discipline or any combination of education and experience providing the types and levels of knowledge, skills, and abilities required by the job. 4 years' experience in a healthcare-related organization assessing (auditing) for regulatory and accreditation compliance, clinical quality improvement, and conducting and documenting performance improvement initiatives to address accrediting and regulatory bodies. Clinical and service quality program management Demonstrated experience in design and implementation of large-scale quality improvement projects. Advanced knowledge of organizational assessments for compliance against accreditation and regulatory requirements Advanced knowledge of medical terminology; health plan HEDIS and CAHPS; Utilization Management and Case Management standards Knowledge of quality improvement principles and project management, including formal training or certification and proven experience leading relevant business process improvement projects and/or quality improvement projects or teamsPreferred Qualifications Master's degree in healthcare administration, Business or Statistics Intermediate level knowledge of health plan data HEDIS, CAHPS, and HOS Intermediate level knowledge of Microsoft Office Access applications Preferred certifications include: CPHQ or equivalent healthcare QI, Lean/Six Sigma, PMP or equivalent project management certification.

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