Healthcare Quality Manager

4 weeks ago

Orange, California, United States El Paso Children's Hospital Full time
About the Position

The Manager Case Management provides shared responsibility for the daily operations, activities, and projects for the Case Management department. This role works under the general direction of the Director of Case Management and in partnership with other department managers to provide performance management and development of the case management staff and projects associated with the department.

Key Responsibilities
  • Cultivate and promote a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity, and accountability.
  • Directs and assists the team in carrying out department responsibilities and collaborates with the leadership team and staff to support short- and long-term goals/priorities for the department.
  • Oversees the collection, production, and submission of health plan HEDIS and Consumer Assessment of Healthcare Providers and Systems (CAHPS) results for all product lines in accordance with Department of Health Care Services (DHCS), CMS, or other regulatory authorities' requirements.
  • Leads and manages the HEDIS team and temporary staff that support HEDIS or other performance measurement deliverables.
  • Hires, trains, reviews, and sets goals for the team.
  • Oversees the production of HEDIS rates for delegated entities.
  • Serves as HEDIS subject matter expert and participates in meetings with delegated entities to educate them about their HEDIS scores and opportunities for improvement.
  • Leads the coordination with HEDIS vendors and auditors.
  • Facilitates the collection of performance measures and reports progress toward goals, including the development of appropriate triggers for determining when a variance from a target warrants further research or quality improvement initiative.
  • Provides reports of quality measures in support of medical functions such as HEDIS, clinical registries, disease management, quality improvement, and case management.
  • Collaborates with the director in departmental budgeting activities.
  • Represents Quality Analytics at various committees and meetings.
  • Provides consultative services to improvement teams as assigned by the Director and leadership.
  • Develops, reviews, and revises policies and procedures.
  • Educates CalOptima Health staff regarding performance measures.
  • Completes other projects and duties as assigned.
Requirements
  • Bachelor's degree required.
  • 5 years of experience managing HEDIS operations from inception to final submissions required.
  • Experience in a managed health care organization working with NCQA, CMS, Department of Health Care Services (DHCS), Department of Managed Health Care (DMHC), and other quality performance standards, metrics, and regulatory requirements required.
  • An equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above is also qualifying.
Preferred Qualifications
  • Master's degree in Public Health, Healthcare, Health Administration, or a related field.

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