Clinical Quality Manager

3 weeks ago

Scottsdale, Arizona, United States The Cigna Group Full time

Job Summary:

The Clinical Quality Manager is responsible for driving successful analysis, design, execution, implementation, and recommendations for initiatives related to Clinical Quality and risk mitigation. This role requires a proactive collaborator who can take a high-level project or initiative vision and strategy, as well as input from key stakeholders, and design a detailed business proposal.

Key Responsibilities:

  • Delivers expertise and leadership in the areas of Event management, Quality data and trend support, Provider peer review, and Policy and Procedure support.
  • Provide oversight to Quality management for ENCG.
  • In collaboration with the Chief of Quality and Nursing, support the overall ENCG Quality Management program inclusive of delegated functions, Peer Review process, Quality of Care and Adverse Event investigation and reporting, NCQA Recognition Programs, Patient Centered Medical Home quality standard implementation, state licensing quality program requirements and process improvement activities to ensure quality patient care provided in ENCG.
  • Quality Clinical Manger will work with the Quality Advisor to identify and create project deliverables to ensure successful execution of projects and initiatives that align to the business strategy, desired capabilities, and corporate mission.
  • Escalate risk and needs to ensure they are addressed considered in project selection/business requirement.
  • Understand the clinical technology applications and processes at a high-level to best be able to document current and future state processes, as well as identify opportunities for process improvement to meet Quality metrics.
  • Collect data, document processes, perform a preliminary analysis, and propose next steps.
  • Facilitate meetings, document meeting minutes and action items, and provide follow ups as needed to ensure follow through on action items for projects and committees.
  • Write and coordinate communications for projects and initiatives.
  • Analyzing and appraising management as to performance of insurance products using measurement criteria; collecting and analyzing data, identifying variance and unacceptable performance, and monitoring correction and ongoing compliance.
  • Implementing quality management process policies and procedures; and managing individual case review and investigation. Utilizes in-depth professional knowledge but is guided by functional practices and well-defined management precedents.
  • Focuses on implementing and executing strategies within own department/discipline/team.
  • Collect data and provide analysis related to Quality measures.
  • Based on a project or initiative vision and strategy, as well as input from the Clinical Team and key stakeholders, design a detailed implementation proposal.
  • Engage sponsors and report outcomes and findings to Chief of Quality and Nursing, stakeholders and sponsors.
  • Identify trends and work with the Chief of Quality and Nursing to close gaps.
  • Become a Subject Matter Expert to provide input and guidance in the areas of regulatory mandates, accreditation and licensing standards, and QM/QI theory.
  • Participates in projects that support strategic organizational initiatives.
  • Other related duties as assigned.

Requirements:

  • Bachelor's degree in Nursing, Health Care Administration or business field of study or equivalent experience.
  • Minimum five years of experience in healthcare. Strong leadership skills including demonstrated ability to confront resistance to change in a fast-paced highly regulated environment.
  • Experience successfully evaluating and implementing quality initiatives.
  • Excellent communication, leadership and teambuilding skills. Ability to effectively present information and respond to questions from groups of managers, providers, customers and market leadership.
  • Knowledge of quality regulatory and accreditation requirements.
  • Excellent computer skills, particularly related to Microsoft Word, Excel, Outlook, Visio, PowerPoint and MS Project.
  • A valid U.S. driver's license, personal vehicle and insurance is required.

Preferred Experience:

  • 3+ year experience as a Quality Manager or similar area of experience.
  • Master's degree in health care or business-related field desired.
  • Valid certificate as a CPHQ Certified Professional in Healthcare Quality. Certification must be maintained by achievement of CEU requirements at least every three years.

About Evernorth Health Services:

Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people.

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