Quality Improvement Manager
4 days ago
The Quality Improvement Manager is a key member of the Santa Clara Family Health Plan team, responsible for overseeing the day-to-day operations of quality improvement and health equity activities. This includes oversight of Healthcare Effectiveness Data and Information Set (HEDIS) reporting, Medicare Stars Program, Consumer Assessment of Healthcare Providers and Systems (CAHPS), and Health Outcomes Survey.
Key Responsibilities- Collaborate with internal business units and external providers and community partners to drive quality improvement projects at the health plan.
- Develop and monitor key performance indicators, metrics, programs, and initiatives related to quality improvement activities.
- Manage the QI and Health Equity and Star programs, including Performance Improvement Projects (PIPs), Quality Improvement Projects (QIPs), HEDIS, quality analytics, and other required regulatory submissions.
- Manage vendors and contractors used for QI and Star programs to ensure they perform according to contract compliance and effectively meet plan needs.
- Identify issues, trends, and opportunities to improve quality or to better assist departments; develop recommendations and implement the same relative to identified issues, trends, and opportunities.
- Maintain a thorough knowledge of applicable laws and regulations in order to effectively monitor and ensure compliance with CMS, DHCS, DMHC, and other applicable agency and program requirements.
- Develop policies and procedures to ensure adherence to contractual, legal, and regulatory requirements.
- Bachelor's Degree in Health Administration, Public Health, Nursing, or related field; or equivalent experience, training, or coursework.
- Master's Degree in Healthcare, Business, or related field.
- Minimum two years of experience with the duties and responsibilities described above, including experience running a full cycle of HEDIS.
- Minimum two years of work experience with a managed care plan, Medi-Cal, and/or Medicare Star programs, hospital, Federally Qualified Health Centers, Indian Health Centers, provider group, Management Services Organization, Independent Physician Associations, health system, or clinic.
- Demonstrated project management and data analysis skills.
- Strong understanding of quality improvement methodologies.
- Ability to think creatively and work strategically to help drive innovative solutions yielding measurable results to the organization.
- Ability to effectively facilitate meetings and deliver information/presentations to management, regulators, or staff.
- Strong working knowledge and proficient with Microsoft Office applications, and the ability to operate all applicable software.
- Excellent oral and written communication skills, including the ability to express oneself clearly and concisely.
- Self-directed with ability to assume responsibility, work independently, organize, prioritize, and effectively manage competing initiatives in a fast-paced, dynamic environment with a high level of ambiguity.
- Ability to direct and manage large-scale, complex, cross-functional, multi-departmental projects to completion with minimum supervision.
- Ability to gather and analyze data, organize and write reports, and organize work efficiently.
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Quality Improvement Manager
2 days ago
San Jose, California, United States Santa Clara Family Health Plan Full timeJob SummaryWe are seeking a highly skilled and experienced Quality Improvement Manager to join our team at Santa Clara Family Health Plan. The successful candidate will be responsible for overseeing the day-to-day operations of quality improvement and health equity activities, including HEDIS reporting, Medicare Stars Program, and Consumer Assessment of...
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Quality Improvement Manager
3 hours ago
San Jose, California, United States Santa Clara Family Health Plan Full timeJob SummaryWe are seeking a highly skilled Quality Improvement Manager to join our team at Santa Clara Family Health Plan. This is a critical role that will oversee the day-to-day operations of our quality improvement and health equity activities.Key ResponsibilitiesCollaborate with internal business units and external partners to drive quality improvement...
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