Quality Improvement Program Manager

4 weeks ago


San Jose, California, United States Santaclara Family Health Plan Full time
Job Summary

The Quality Improvement Program Manager will develop and execute a strategy to improve the quality performance for Santa Clara Family Health Plan. This role serves as a critical resource and subject matter expert in supporting, monitoring, managing, and driving strategic projects, interventions, and initiatives for the organization's Medicaid quality improvement program.

Key Responsibilities
  • Implement strategies and initiatives on the HEDIS & MCAS work plan, including managing projects of varying degrees of complexity.
  • Independently produce and manage prospective quality reports with analysis to manage program performance, support rating predictions, and support meetings with delegates, provider groups, and internal stakeholders.
  • Interpret and organize information around current performance, historical trends, predicted performance, and opportunities for improvement.
  • Provide comprehensive analysis of measures, barriers, and opportunities, and present results of improvement efforts and ongoing performance measures to management.
  • Serve as a subject matter expert (SME) on HEDIS & MCAS measures, including the measures that apply to each contract and the organization's strategy for achieving the highest possible rating for each contract.
Requirements
  • Bachelor's Degree in Public Health, Healthcare, or a related field, or equivalent experience.
  • Minimum three years of experience with quality improvement in health-related settings, including performing root cause analysis, Plan Do Study Act methodology, and monitoring/analyzing improvement, program development.
  • Knowledge of Medicaid principles and practices with emphasis in quality improvement.
  • Proven ability to design and execute strategic plans for continuous improvement initiatives.
  • HEDIS experience.
Working Conditions

Generally, duties are primarily performed in an office environment while sitting or standing at a desk. Incumbents are subject to frequent contact with and interruptions by co-workers, supervisors, and plan members or providers in person, by telephone, and by work-related electronic communications.



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