Quality Improvement Manager

2 weeks ago

San Jose, California, United States Santa Clara Family Health Plan Full time
Quality Improvement Manager

Salary Range: $126,818 - $196,568
The anticipated compensation range is influenced by various factors, including experience, education, and market conditions. This range may be adjusted over time.

FLSA Status: Exempt
Department: Quality Improvement
Reports To: Director of Quality and Process Improvement

POSITION OVERVIEW
The Quality Improvement Manager is responsible for supervising the daily functions of quality enhancement and health equity initiatives within the health plan. This role encompasses the management of Healthcare Effectiveness Data and Information Set (HEDIS) reporting, the Medicare Stars Program, Consumer Assessment of Healthcare Providers and Systems (CAHPS), and Health Outcomes Survey. The Quality Improvement Manager collaborates across departments to facilitate projects aimed at enhancing care quality and service delivery while addressing health disparities. This position also entails leading and overseeing the team engaged in these efforts.

KEY RESPONSIBILITIES

  1. Engage with internal departments and external healthcare providers and community organizations to advance quality improvement initiatives that enhance care and service quality.
  2. Establish and track key performance indicators, metrics, programs, and initiatives related to quality improvement activities, including data collection, analysis, and reporting through appropriate statistical methods.
  3. Oversee the Quality Improvement and Health Equity programs, including Performance Improvement Projects (PIPs), Quality Improvement Projects (QIPs), HEDIS, quality analytics, and other mandatory regulatory submissions.
  4. Manage additional projects that contribute to quality outcomes and align with organizational objectives.
  5. Supervise vendors and contractors involved in Quality Improvement and Stars programs to ensure compliance with contractual obligations and effective performance to meet organizational needs.
  6. Identify trends, issues, and opportunities for quality enhancement or departmental support; formulate recommendations and implement solutions based on identified needs.
  7. Maintain comprehensive knowledge of relevant laws and regulations to ensure compliance with CMS, DHCS, DMHC, and other applicable agency requirements.
  8. Develop policies and procedures to ensure compliance with contractual, legal, and regulatory standards.
  9. Participate in off-site meetings or events as required.
  10. Perform other related duties as assigned.

MANAGEMENT RESPONSIBILITIES

This role involves management responsibilities in accordance with the organization's policies and applicable regulations. Responsibilities include:

  1. Recruiting, interviewing, and hiring staff.
  2. Fostering a high-performance culture within the department and motivating team members to achieve organizational goals.
  3. Training and mentoring staff, including cross-training existing employees and initiating retraining as necessary.
  4. Setting objectives and planning, assigning, and directing work in alignment with those objectives, ensuring employees have the resources needed to perform their tasks.
  5. Evaluating performance, recognizing and addressing employee issues, and providing regular feedback and timely performance reviews.

QUALIFICATIONS

The qualifications listed below represent the knowledge, skills, and abilities required for this position:

  1. Bachelor's Degree in Health Administration, Public Health, Nursing, or a related field; or equivalent experience, training, or coursework. (Required)
  2. Master's Degree in Healthcare, Business, or a related field. (Desired)
  3. At least two years of experience in the responsibilities outlined above, including experience managing a full cycle of HEDIS. (Required)
  4. A minimum of two years of experience in a managed care plan, Medi-Cal and/or Medicare Star programs, hospitals, Federally Qualified Health Centers, Indian Health Centers, provider groups, Management Services Organizations, Independent Physician Associations, health systems, or clinics. (Required)
  5. Proven project management and data analysis capabilities. (Required)
  6. Strong grasp of quality improvement methodologies. (Required)
  7. Creative thinking and strategic working abilities to drive innovative solutions with measurable outcomes. (Required)
  8. Effective facilitation skills for meetings and presentations to management, regulators, or staff. (Required)
  9. Proficient in Microsoft Office applications and capable of operating relevant software. (Required)
  10. Excellent oral and written communication skills, with the ability to convey information clearly and concisely. (Required)
  11. Self-motivated with the ability to take responsibility, work independently, prioritize tasks, and manage competing initiatives in a dynamic environment. (Required)
  12. Ability to lead and manage large-scale, complex, cross-functional projects to completion with minimal supervision. (Required)
  13. Capability to gather and analyze data, prepare reports, and organize work efficiently. (Required)
  14. Ability to exercise good judgment and initiative in decision-making within the scope of the position. (Required)
  15. Commitment to maintaining confidentiality. (Required)
  16. Willingness to travel for offsite conferences, meetings, or events. (Required)
  17. Adherence to all organizational policies and procedures. (Required)
  18. Ability to perform the job safely, respecting others and property. (Required)
  19. Maintenance of a valid California driver's license and acceptable driving record for travel to offsite meetings or events; or the ability to utilize alternative transportation methods. (Required)

WORKING ENVIRONMENT

Generally, duties are performed in an office setting, involving regular interaction with colleagues, managers, external partners, and vendors through various communication methods.

PHYSICAL DEMANDS

Incumbents must be capable of fulfilling the essential functions of this position, with or without reasonable accommodation.

  1. Mobility: Regular bending, reaching overhead, and sitting or standing for extended periods. (Required)
  2. Lifting: Ability to lift and carry files and office supplies weighing up to 5 pounds. (Required)
  3. Vision: Ability to read printed materials and computer screens; clarity of vision is required at 20 inches or less. (Required)
  4. Dexterity: Regular use of hands and fingers for keyboarding and operating office equipment. (Required)
  5. Hearing/Talking: Ability to hear and communicate effectively in person and over the phone. (Required)
  6. Reasoning: Ability to think critically and serve customers effectively while maintaining attention to detail. (Required)

ENVIRONMENTAL CONDITIONS
Typical office conditions with potential exposure to moderate noise levels.

EOE

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