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Quality Improvement Program Manager, RN

4 months ago

Rancho Cucamonga, United States Inland Empire Health Plan Full time

What you can expect

Find joy in serving others with IEHP We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience

Under the direction of department leadership, the Quality Improvement Program Manager will drive quality improvement initiatives across the continuum of care (i.e. acute care hospitals, skilled nursing facilities, hospice agencies, etc.) to enhance the overall quality of care delivered to Members. Responsible for identifying, developing, coordinating, promoting, supporting, and implementing assigned clinical quality, and/or service improvement projects and programs, the Quality Improvement Program Manager acts as a lead for evidence-based practice integration, provider training/education, policy review/development, and regulatory/accreditation interpretation. Specifically, develops continuous and targeted activities to improve performance related to Centers for Medicare & Medicaid Services (CMS) Star Ratings, HEDIS, CAHPS, HOS, P4P and other identified performance measures. Manages multiple complex initiatives that impact the quality or effectiveness of health care delivery and/or health care services. Acts in conjunction with both external facing and plan quality improvement leaders and key stakeholders to provide support for multi-disciplinary teams.

Major Functions (Duties and Responsibilities)

1. Lead multi-department/cross-functional committees; including IEHP and external stakeholder workgroups which support key quality improvement initiatives. Accountable to broad-scale improvement efforts including Hospital value-based incentives (P4P, VBI, VBP, etc.), network-wide CMS star ratings and individual domain-level performance. 2. Develop collaborative relationships with contracted hospitals, skilled nursing facilities, hospice agencies, providers, and other external partners to promote participation in quality improvement collaboratives (i.e. forums to enhance shared learning opportunities and/or share best practices) to improve clinical care outcomes. 3. Utilize knowledge of advanced clinical processes and/or hospital operations to collaboratively develop and implement targeted activities (i.e., those based on current outcome performance and/or aligned with industry best-practices) to drive improvements in CMS Star Ratings, HEDIS, CAHPS, HOS, P4P and other identified performance measures 4. Research evidence-based practices, national and regional benchmarks, and industry standards and integrates findings into improvement initiatives. 5. Perform continuous monitoring of improvement activities via concurrent analysis of measure outcomes. 6. Analyze performance outcomes and provide meaningful feedback (i.e., specific, measurable, relevant, timely, etc.) to external partners in relation to process improvement enhancements. 7. Effectively utilize performance improvement methodologies (i.e., Plan Do Study Act (PDSA)) lead the development, refinement, and implementation of rapid-cycle performance improvement. 8. Participate and describe outreach initiatives, potential/experienced barriers, and activities to resolve issues and improve outcomes. 9. Participate in the development and maintenance of annual quality improvement program documents and evaluations, compliance audits, policies and procedures, and improvement activities. 10. Support the development, upgrade, and delivery of comprehensive quality improvement training programs and problem-solving methodologies/tools to QI teams and other stakeholders as needed in collaboration with the quality improvement team. 11. Lead intradepartmental quality improvement teams, programs, projects, and initiatives as assigned. 12. Continuously seek to enhance delivery and efficiency of external-facing quality improvement initiatives via technological advancement and internal-facing process improvement. 13. Translate data into meaningful information, draw conclusions, and relate findings to industry standards. Provide recommendations to departmental stakeholders and Quality Improvement Leadership Team regarding performance gaps, program implementation, and performance outcomes in order to maintain an effective Quality Improvement program. 14. Any other duties as required ensuring Health Plan operations are successful.

Commitment to Quality: The IEHP Team is committed to incorporate IEHP’s Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation.

Perks

IEHP is not only committed to healing and inspiring the human spirit of our Members; we also aim to match our Team Members with the same energy by providing prime benefits and more.

CalPERS retirement 457(b) option with a contribution match Generous paid time off- vacation, holidays, sick State of the art fitness center on-site Medical Insurance with Dental and Vision Paid life insurance for employees with additional options Short-term, and long-term disability options Pet care insurance Flexible Spending Account – Health Care/Childcare Wellness programs that promote a healthy work-life balance Career advancement opportunities and professional development Competitive salary with annual merit increase Team bonus opportunities

Education & Experience

Minimum six (6) years of experience in a clinical/health care environment with demonstrated experience at a professional level in quality improvement/clinical program oversight/project management. Bachelor’s degree in science or health/healthcare related field from an accredited institution required. Certified Professional of Healthcare Quality (CPHQ), or other recognized quality improvement certificate required or within one (1) year of hire (maintained through employment). Minimum possession of one of the following active, unrestricted, and unencumbered clinical licenses required: Registered Nurse (RN) license issued by the California BRN Advanced clinical licensure issued by appropriate State Board (i.e. PA)

Key Qualifications

Must have a valid California Driver’s license and valid automobile insurance. Must qualify and maintain driving record to drive company vehicles based on IEHP insurance standards of no more than three (3) points. Working knowledge of healthcare quality performance and measurement sets including CMS quality withhold, Managed Care Accountability Set, NCQA Quality Improvement Standards and HEDIS. Ability to apply knowledge of project management techniques, tools of continuous improvement, and work process redesign. Knowledge of advanced clinical processes and/or hospital operations. Requires knowledge of the local healthcare market, patient demographics and needs and plan-specific information. Proficient in all Microsoft Office applications, with an emphasis on Excel, PowerPoint and Visio.

Start your journey towards a thriving future with IEHP and apply TODAY #J-18808-Ljbffr