Quality Improvement Manager
3 weeks ago
We are seeking a highly skilled 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 at the health plan. 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 to improve quality of care and quality of service.
- Develop and monitor key performance indicators, metrics, programs and initiatives related to quality improvement activities including collecting, analyzing and reporting by appropriate statistical reports.
- 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 other projects as needed that support quality outcomes and organizational goals.
- Manage vendors and contractors used for QI and Star programs to ensure they perform according to contract compliance and effectively to 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.
- Attend off site meetings or events as necessary.
- Bachelor's Degree in Health Administration, Public Health, Nursing, or related field; or equivalent experience, training, or coursework.
- 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.
- Ability to effectively facilitate meetings and deliver information/presentations to management, regulators, and staff.
- 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 think creatively and work strategically, to help drive innovative solutions yielding measurable results to the organization.
- Ability to gather and analyze data, organize and write reports, and organize work efficiently.
- Ability to take initiative and exercise good judgment when making decisions within the scope of the position.
- Ability to maintain confidentiality.
- Ability to travel for in-person offsite conferences, meetings or events.
- Ability to comply with all SCFHP policies and procedures.
- Ability to perform the job safely with respect to others, to property, and to individual safety.
- Maintenance of a valid California driver's license and acceptable driving record, in order to drive to and from offsite meetings or events; or ability to use other means of transportation to attend offsite meetings or events.
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