Quality Improvement Manager

1 week ago

Smithfield, Rhode Island, United States Neighborhood Health Plan of RI Full time
Job Title: Quality Improvement Manager

Neighborhood Health Plan of Rhode Island is seeking a highly skilled Quality Improvement Manager to join our team. As a key member of our organization, you will play a critical role in leading our quality improvement efforts and ensuring that we provide the highest level of care to our members.

Key Responsibilities:
  • Lead the development and implementation of quality improvement initiatives to optimize HEDIS and Stars measures
  • Collaborate with internal stakeholders to identify and prioritize innovation and improvement opportunities
  • Monitor performance in HEDIS and Stars measures and develop processes to support continuous quality improvement
  • Evaluate the effectiveness of quality improvement initiatives and provide recommendations to internal and external stakeholders
  • Oversee provider engagement and enablement to improve performance in HEDIS, Stars, and other quality programs
  • Provide subject matter expertise in support of quality improvement committees and initiatives
  • Engage in ongoing performance management of staff, including coaching, mentoring, development, training, and succession planning
Requirements:
  • Bachelor's degree in Business Administration, Health Care Administration, Public Health, or a related field
  • Five years of experience in a managed care organization or a healthcare-related organization, including experience with Medicaid and/or commercial lines of business
  • Knowledge and experience in data collection, specifications, and key performance drivers of all Stars Measures
  • Two or more years of direct experience facilitating and/or leading quality improvement or business process improvement efforts, preferably related to healthcare
  • Two or more years of experience overseeing teams/management experience
  • Experience with NCQA accreditation survey requirements for health plans with HEDIS specifications and with state and federal healthcare regulations applicable to managed care organizations
  • Experience in providing leadership to formal and informal group processes supporting priority setting and program implementation
  • Experience in management and supervision of staff, including staff with technical responsibilities
Preferred Qualifications:
  • Masters degree in Business Administration, Health Care Administration, Public Health, or a related field
  • Demonstrated experience with Medicare Stars
  • National Association of Healthcare Quality certification as a Certified Professional in Healthcare Quality/Organizational Excellence (CPHQ/OE) or similar QI training

Neighborhood Health Plan of Rhode Island is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status.

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