Quality Improvement Program Manager

2 months ago

Orange, California, United States Astiva Health, Inc Full time

Job Title: Manager of Quality Improvement

Target Compensation Range: $95,000-$115,000/year, depending on the level of relevant qualifications and experience.

About Us:

Astiva Health, Inc. is a leading healthcare organization focused on Medicare and HMO services. We are dedicated to providing comprehensive care that meets the diverse needs of our community, emphasizing accessibility, affordability, and quality in every aspect of our services. Our mission is to innovate healthcare delivery and positively impact the lives of our members.

SUMMARY: The Manager of Quality Improvement oversees essential medical management functions, including Quality Management, Quality Improvement (QI), Risk Adjustment Factors, and Quality Assurance. This pivotal role is responsible for enhancing operational efficiencies and advancing capabilities in alignment with Astiva's strategic objectives.

ESSENTIAL DUTIES AND RESPONSIBILITIES include:

  • Leading strategy, deployment, and workflow development to ensure operational compliance and achievement of quality metrics.
  • Ensuring adherence to state and federal regulations through consistent operational compliance and reporting.
  • Collaborating with senior management to establish a strategic vision for STARS improvement as part of Astiva's business planning.
  • Formulating and executing strategies to enhance HEDIS, CAHPS, HOS, and other STARS-related measures.
  • Overseeing the development and monitoring of reporting procedures to track deliverables and budget adherence.
  • Annually revising the QI program, including evaluation and work plans, and presenting for review and implementation.
  • Creating quarterly progress reports on QI activities.
  • Reporting to the Quality Improvement Committee (QIC) on ongoing quality improvement initiatives.
  • Managing the health plan's credentialing program operations.
  • Ensuring compliance with all relevant regulations at the federal, state, and local levels.
  • Working collaboratively with internal departments to uphold the QI program's policies and procedures.
  • Facilitating reports and discussions with the Utilization Management/Quality Assurance Committee and Board of Directors.
  • Conducting comprehensive reviews in a timely manner.
  • Compiling and analyzing data on risk adjustment factors (RAF).
  • Implementing strategies to enhance risk adjustment processes and ensure accurate data collection.
  • Conducting audits to verify risk adjustment accuracy and completeness.
  • Recruiting and retaining skilled staff to support strategic and operational goals.
  • Engaging regularly with providers, members, employees, auditors, and regulators as necessary.
  • Maintaining regular and consistent attendance.
  • Performing other duties as assigned.

EDUCATION and/or EXPERIENCE:

  • 7+ years of experience in Managed-Care operations at a managerial level.
  • 5+ years of Quality Improvement experience, preferably at the plan level.
  • Experience in developing health plan QI programs.
  • Master's degree in Public Health, Health Science, or RN/NP/BSN licensure.
  • Preferred experience with HMO, Medi-Cal/Medicaid, Medicare, or relevant government client/public service.
  • Experience presenting to a Board of Directors and formulating strategic goals.
  • Experience with oversight of medical groups, IPAs, and contracted healthcare entities.

OTHER SKILLS and ABILITIES:

  • Ability to analyze and update policies related to Quality and Population Health Management Programs.
  • In-depth knowledge of HEDIS, CAHPS, HOS, STARS, RAF, HCC, and other quality measures.
  • Comprehension of major functions within the health plan environment.
  • Strong leadership skills to influence and manage effectively.
  • Excellent problem-solving, analytical, and organizational skills.
  • Clear and concise communication skills, both verbal and written.

BENEFITS:

  • 401(k)
  • Dental Insurance
  • Health Insurance
  • Life Insurance
  • Vision Insurance
  • Paid Time Off

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