Manager of Quality Improvement
2 weeks ago
The Manager of Quality Improvement supports the Senior Manager of Quality Improvement and Accreditation by leading the identification and design of company-wide quality improvement (QI) efforts and provides direction to the implementation of QI efforts through cross-functional work teams, department workgroups and/or other ad hoc teams. This position leads the organization's efforts to obtain the highest level of performance in quality measures including NCQA Medicaid Health Plan Ratings, Stars and Rhode Island pay for performance programs This position supports the company's efforts for obtaining the Network Plan and the Benefit Determination and Utilization Review Certifications through the Office of the Health Insurance Commissioner. This position supports the Senior Manager of QI and Accreditation in the oversight of delegated activities related to quality improvement and ensures comprehensive oversight and monitoring of the delegate.
Duties and ResponsibilitiesResponsibilities include, but are not limited to, the following:
- Works with internal standing committees and inter-departmental work groups to identify and prioritize innovation and improvement opportunities. Helps align senior leader support for suggested organizational changes/projects and presentation to selected audiences
- Lead the development and implementation of programs and interventions to optimize HEDIS, Stars and other quality performance programs.
- Monitor performance in HEDIS and Stars measures and develop processes to support continuous quality improvement.
- Evaluate effectiveness of quality improvement initiatives, providing recommendations to internal and external stakeholders.
- Oversee provider engagement and enablement to improve performance in HEDIS, Stars and other quality programs.
- Provides subject matter expertise in support of the agenda and work of quality improvement committees
- Engage in on-going performance management of staff including coaching, mentoring, development, training and succession planning to include hiring and termination decisions
- Serves as the subject matter expert on models for quality improvement methods, standards, and applications, and for data management and display related to QI
- Assists other departments with business process/quality improvement projects
- Supports the analysis of annual HEDIS data and the information on performance from NCQA Health Plan Stars Rating to help identify high-priority improvement and innovation opportunities for the organization
- Leads cross-functional inter-departmental team which plans, organizes, coordinates and identifies improvement opportunities in support of achieving the highest level of NCQA Health Plan Stars Rating for Medicaid, Medicare and commercial products
- Responsible for the organization's bi-annual filings with the Office of the Health Insurance Commissioner (OHIC) to obtain Network Plan and the Benefit Determination and Utilization Review Certifications
- Responsible for the "Material Modification" of the organization's OHIC Network Plan and Benefit Determination and Utilization Review Certifications
- Maintains current knowledge of all present and future quality mandates from regulatory bodies including NCQA, Executive Office of Health and Human Services, Centers for Medicare and Medicaid Services and other regulatory bodies
- Other duties as assigned
- Corporate Compliance Responsibility - As an essential function, responsible for complying with Neighborhood's Corporate Compliance Program, Standards of Business Conduct, applicable contracts, laws, rules and regulations, policies and procedures as it applies to individual job duties, the department, and the Company. This position must exercise due diligence to prevent, detect and report unlawful and/or unethical conduct by fellow co-workers, professional affiliates and/or agents
Qualifications
Required:
- Bachelor's degree in Business Administration, Health Care Administration, Public Health or related field
- Five (5) years' experience in a managed care organization or a health care-related organization, including experience with Medicaid and/or commercial lines of business
- Knowledge and experience in data collection, specifications, and key performance drivers of all Stars Measures
- Two (2) or more years of direct experience facilitating and/or leading quality improvement or business process improvement efforts, preferably related to health care
- Two (2) or more years of experience overseeing teams/management experience
- Experience with NCQA accreditation survey requirements for health plan with HEDIS specifications, and with state and federal health care regulations applicable to managed care organizations
- Experience in providing leadership to formal and informal group processes supporting priority setting and program implementation
- Experience in management and supervision of staff, including staff with technical responsibilities
- Must be detailed-oriented, able to exercise sound judgment in making decisions, able to work independently in a flexible environment and able to manage multiple projects in an efficient, timely manner
- Strong ability to conduct both quantitative and qualitative analysis and identify opportunity for improvement as well as activities to address the opportunities
- Strong ability to represent the company in statewide initiatives
- Strong presentation, project management, interpersonal and oral and written communication skills
- Strong ability to foster an environment of learning and empowerment
- Strong computer skills required (Excel, Word, PowerPoint, MS Project research)
Preferred:
- Masters degree in Business Administration, Health Care Administration, Public Health or related field
- Demonstrated experience with Medicare Stars
- National Association of Healthcare Quality certification as a Certified Professional in Healthcare Quality/Organizational Excellence (CPHQ/OE) or similar QI training
Neighborhood Health Plan of Rhode Island is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status.
-
Quality Improvement Manager
1 week ago
Smithfield, Rhode Island, United States Neighborhood Health Plan of RI Full timeJob Title: Quality Improvement ManagerNeighborhood Health Plan of Rhode Island is seeking a highly skilled Quality Improvement Manager to join our team. As a key member of our organization, you will play a critical role in leading our quality improvement efforts and ensuring that we provide the highest level of care to our members.Key Responsibilities:Lead...
-
Smithfield, Rhode Island, United States Neighborhood Health Plan of RI Full timeJob SummaryWe are seeking a highly skilled Senior Manager of Quality Improvement and Analysis to lead our organization's efforts in implementing and maintaining high-quality healthcare services. As a key member of our team, you will be responsible for overseeing the development and implementation of quality improvement initiatives, analyzing data to identify...
-
Smithfield, Ohio, United States Neighborhood Health Plan of RI Full timeJob SummaryWe are seeking a highly skilled Senior Manager of Quality Improvement and Analysis to lead our organization's efforts in implementing and maintaining high-quality healthcare services. This role will oversee the development and implementation of quality improvement initiatives, analyze data to identify areas for improvement, and collaborate with...
-
Smithfield, United States Neighborhood Health Plan of RI Full timeJob Details Job Location Smithfield, RI - Smithfield, RI Position Type Full Time Education Level Bachelors Degree Travel Percentage Occasional Job Shift Daytime Job Category Management Description The Senior Manager of Quality Improvement and Analysis is Neighborhood's organizational lead for implementing all facets of the Healthcare Effectiveness Data...
-
Corporate Director, Continuous Improvement
2 weeks ago
Smithfield, United States Smithfield Foods Full timeIf you are currently employed at Smithfield, please log into Workday and submit your application through the Jobs Hub. A great job-and a great future-awaits you at Smithfield Foods. We are an American food company with a leading position in packaged meats and fresh pork products. We're looking for motivated people who want to join our team and grow lasting...
-
Corporate Director of Continuous Improvement
2 weeks ago
Smithfield, Virginia, United States Smithfield Foods Full timeJob Title: Corporate Director, Continuous ImprovementSmithfield Foods is seeking a highly motivated and experienced Corporate Director, Continuous Improvement to lead our efforts in driving operational excellence across the organization.Key Responsibilities:Develop and implement strategic process improvements to reduce operating costs and boost...
-
Quality Assurance Manager
2 weeks ago
Smithfield, Utah, United States UFM Full timeJob Title: Quality Assurance ManagerUtah Flour Milling (UFM) is seeking a highly skilled Quality Assurance Manager to lead our quality assurance team and ensure the highest standards of food safety and quality in our facility.Key Responsibilities:Develop and implement quality assurance programs to ensure compliance with FSMA requirements, GFSI standards, and...
-
Supplier Quality Engineer
4 months ago
Smithfield, United States LHH Full timeLHH is working with a manufacturing company around Smithfield, NC that is seeking a Supplier Quality Engineer. This role will be onsite and working in a team environment. Company is offering a competitive salary and bonus. If you are seeking a new role where you want to be able to make a difference then this is for you!Responsibilities:Review engineering...
-
Supplier Quality Engineer
4 months ago
Smithfield, United States LHH Full timeLHH is working with a manufacturing company around Smithfield, NC that is seeking a Supplier Quality Engineer. This role will be onsite and working in a team environment. Company is offering a competitive salary and bonus. If you are seeking a new role where you want to be able to make a difference then this is for you!Responsibilities:Review engineering...
-
Quality Assurance Internship
3 weeks ago
Smithfield, Utah, United States Schreiber Foods Full timeJob DescriptionAs a Quality Assurance Intern at Schreiber Foods, you will have the opportunity to work on real-world projects, participate in team meetings, and contribute your ideas to improve food safety and quality initiatives. This internship is designed to prepare successful interns for a possible future career with Schreiber Foods.ResponsibilitiesLead...
-
Residential Program Manager
4 weeks ago
Smithfield, Rhode Island, United States The City of Providence Full timeJob SummaryWe are seeking a highly skilled and compassionate Residential Program Manager to join our team at The City of Providence. As a key member of our residential treatment team, you will be responsible for providing leadership and guidance to our staff, ensuring the safety and well-being of our residents, and promoting a positive and supportive living...
-
Quality Assurance Internship Opportunity
4 weeks ago
Smithfield, Utah, United States Schreiber Foods Full timeJob SummaryWe are seeking a highly motivated and detail-oriented Quality Assurance Intern to join our team at Schreiber Foods. As a Quality Assurance Intern, you will have the opportunity to work on real-world projects, participate in team meetings, and contribute your ideas to improve our food safety and quality initiatives.Key ResponsibilitiesLead small...
-
Quality Assurance Internship Opportunity
4 weeks ago
Smithfield, Utah, United States Schreiber Foods Full timeJob SummaryWe are seeking a highly motivated and detail-oriented Quality Assurance Intern to join our team at Schreiber Foods. As a Quality Assurance Intern, you will have the opportunity to work on real-world projects, participate in team meetings, and contribute your ideas to improve our food safety and quality initiatives.Key ResponsibilitiesLead small...
-
Residential Manager
2 weeks ago
Smithfield, Rhode Island, United States The City of Providence Full timeResidential Manager Job SummaryWe are seeking a highly skilled and compassionate Residential Manager to oversee the daily operations of our residential facility. As a key member of our team, you will be responsible for ensuring the safety, well-being, and care of our residents.Key Responsibilities:Supervise program staff and ensure compliance with agency and...
-
Quality Assurance Internship Opportunity
4 weeks ago
Smithfield, Utah, United States Schreiber Foods Full timeJob SummaryWe are seeking a highly motivated and detail-oriented Quality Assurance Intern to join our team at Schreiber Foods. As a Quality Assurance Intern, you will have the opportunity to work on various projects related to food safety and quality initiatives, company objectives, and plant-specific assignments.Key ResponsibilitiesLead small quality...
-
Pathology Manager
6 days ago
Smithfield, North Carolina, United States WakeMed Full timeAbout WakeMedOur MissionAt WakeMed, our mission is to improve the health and well-being of our community. We are committed to providing outstanding and compassionate care to our patients. Our team of healthcare professionals is dedicated to delivering exceptional patient care and service.Position OverviewThe Core Laboratory Pathology Manager is a critical...
-
Grants Management Specialist
1 month ago
Smithfield, United States DC Department of Human Resources Full timeGeneral Job Information Job Summary This position is in the Office of the Deputy Mayor for Public Safety and Justice (DMPSJ). This position is primary responsible for grants management processes to ensure compliance, documenting policies, procedures, recordkeeping, and reporting reading all grant activity within the agency. The incumbent and...
-
Agricultural Equipment Technician
4 weeks ago
Smithfield, North Carolina, United States Quality Equipment Full timeService Technician Job DescriptionWe are a John Deere dealer with 36 locations serving a diverse group of agricultural, commercial, and residential customers in North Carolina, South Carolina, and Virginia. At Quality Equipment, we pride ourselves on our commitment to our customers, our employees, and our community.Key Responsibilities:Perform basic...
-
Nurse Quality Assurance Specialist
2 weeks ago
Smithfield, Ohio, United States Incredible Health Full timeIncredible Health is actively hiring for a Registered Nurse - Quality Assurance position in the Smithfield, VA area. We're seeking experienced nurses with expertise in Audit, Patient Safety, or Performance Improvement. The ideal candidate will have a strong background in quality assurance and be able to work in a fast-paced environment. The position offers a...
-
Maintenance Manager
5 days ago
Smithfield, Ohio, United States Jobot Full timeJob OverviewWe are seeking an experienced Maintenance Manager to join our team at a global leader in air filtration solutions. This is a permanent position with a competitive compensation package and relocation assistance.Key ResponsibilitiesOversee and manage all aspects of our maintenance operations, including preventive maintenance, equipment maintenance,...
