Quality Assurance and Training Manager

6 days ago

North Smithfield, Rhode Island, United States Neighborhood Health Plan of RI Full time

Job Summary

The Manager of Quality Assurance and Training will support the Senior Manager of Quality Improvement and Accreditation by leading the identification and design of company-wide quality improvement efforts and providing direction to the implementation of QI efforts through cross-functional work teams, department workgroups, and/or other ad hoc teams.

Key Responsibilities

  • Lead the organization's efforts to obtain the highest level of performance in quality measures, including NCQA Medicaid Health Plan Ratings, Stars, and Rhode Island pay for performance programs.
  • Support the company's efforts for obtaining the Network Plan and the Benefit Determination and Utilization Review Certifications through the Office of the Health Insurance Commissioner.
  • Support the Senior Manager of QI and Accreditation in the oversight of delegated activities related to quality improvement and ensure comprehensive oversight and monitoring of the delegate.
  • Helps align senior leader support for suggested organizational changes/projects and presentation to selected audiences.
  • Lead the development and implementation of programs and interventions to optimize HEDIS, Stars, and other quality performance programs.
  • Monitor performance in HEDIS and Stars measures and develop processes to support continuous quality improvement.
  • Evaluate effectiveness of quality improvement initiatives, providing recommendations to internal and external stakeholders.
  • Oversee provider engagement and enablement to improve performance in HEDIS, Stars, and other quality programs.
  • Provides subject matter expertise in support of the agenda and work of quality improvement committees.
  • Engage in on-going performance management of staff, including coaching, mentoring, development, training, and succession planning to include hiring and termination decisions.
  • Serves as the subject matter expert on models for quality improvement methods, standards, and applications, and for data management and display related to QI.
  • Assists other departments with business process/quality improvement projects.
  • Supports the analysis of annual HEDIS data and the information on performance from NCQA Health Plan Stars Rating to help identify high-priority improvement and innovation opportunities for the organization.
  • Leads cross-functional inter-departmental team which plans, organizes, coordinates, and identifies improvement opportunities in support of achieving the highest level of NCQA Health Plan Stars Rating for Medicaid, Medicare, and commercial products.
  • Responsible for the organization's bi-annual filings with the Office of the Health Insurance Commissioner (OHIC) to obtain Network Plan and the Benefit Determination and Utilization Review Certifications.
  • Responsible for the "Material Modification" of the organization's OHIC Network Plan and Benefit Determination and Utilization Review Certifications.
  • Maintains current knowledge of all present and future quality mandates from regulatory bodies, including NCQA, Executive Office of Health and Human Services, Centers for Medicare and Medicaid Services, and other regulatory bodies.
  • Corporate Compliance Responsibility

As an essential function, responsible for complying with Neighborhood's Corporate Compliance Program, Standards of Business Conduct, applicable contracts, laws, rules, and regulations, policies, and procedures as it applies to individual job duties, the department, and the Company.

Requirements

  • Bachelor's degree in Business Administration, Health Care Administration, Public Health, or related field.
  • Five (5) years' 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 (2) or more years of direct experience facilitating and/or leading quality improvement or business process improvement efforts, preferably related to healthcare.
  • Two (2) 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.
  • Must be detailed-oriented, able to exercise sound judgment in making decisions, able to work independently in a flexible environment, and able to manage multiple projects in an efficient, timely manner.
  • Strong ability to conduct both quantitative and qualitative analysis and identify opportunities for improvement as well as activities to address the opportunities.
  • Strong presentation, project management, interpersonal, and oral and written communication skills.
  • Strong computer skills required (Excel, Word, PowerPoint, MS Project research).
  • Masters degree in Business Administration, Health Care Administration, Public Health, or related field.
  • National Association of Healthcare Quality certification as a Certified Professional in Healthcare Quality/Organizational Excellence (CPHQ/OE) or similar QI training.

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