Quality Manager

4 weeks ago

Chicago Illinois, United States Acentra Health Full time
Who we need:

Acentra Health is seeking a Quality Manager to join our team. As the Quality Manager, you will be responsible for developing, implementing, and monitoring quality and performance improvement activities and clinical outcomes for our organization. You will play a key role in supporting both medical and behavioral health departments in delivering high-quality care.

What you'll do:

Lead and facilitate all Quality and Performance Improvement (QPI) activities across the organization

Provide coaching and support to managers and staff regarding QPI

Ensure the implementation of key performance indicators and maintain systems for tracking, reporting, and improving performance

Assist in developing benchmarks for quality measures and outcomes

Facilitate access to relevant policies, procedures, and resources for staff

Promote awareness of customer requirements throughout the organization

Participate in existing CQI activities, quality/outcome studies, and program development

Lead local quality improvement committee and participate in clinical practice oversight committee

Support quality of care reviews and assist in resolving member grievances or complaints

Monitor and ensure staff have appropriate credentials and training

Conduct audits of utilization and case management cases

Monitor and report on quality indicators to identify opportunities for improvement

Develop and maintain Quality Improvement Processes (QIPs) in alignment with regulatory requirements

Evaluate program effectiveness and document quality metrics

Review member satisfaction surveys and compare to performance indicators

Report critical incidents to corporate compliance and assist with action plans

Execute CQI plans to meet business requirements

Participate in preparing quarterly and annual quality reports for clients

Identify patterns and trends in clinical case and utilization management performance

Maintain the Department's Quality Management Plan and Program Description

Coordinate with Subject Matter Experts (SMEs) in developing clinical solutions

Support commercial implementations and RFP/proposal processes for clients

Requirements:

Active unrestricted nursing license, or other applicable State and/or Compact State clinical licensure

Bachelor's degree in nursing

Formal training or certification in quality desired (CPHQ, ISO, Six Sigma)

Quality management experience in a health-related field

Solutioning and problem-solving experience in utilization and case management programs

Minimum of 2 years case management experience

Minimum of 1 year utilization management experience (preferred)

Experience with commercial health plans and/or clinical programs (preferred)

Knowledge of performance improvement strategies, principles, methodologies, techniques, and data analysis

Ability to provide leadership, maintain confidentiality, and meet deadlines

In-depth knowledge of CQI tools, methods, and techniques such as Six Sigma

Excellent grasp and understanding of Statistical Process Control (SPC)

Knowledge of URAC, NCQA, and/or ISO background (a plus)

Strong analytical skills and ability to evaluate data objectively

Excellent communication, organizational, presentation, and interpersonal skills

Proficient in MS Office applications and internet/web navigation

Requirements

Qualifications:

Active unrestricted nursing license, or other applicable State and/or Compact State clinical licensure required

Bachelor's degree in nursing required

Formal training or certification in quality desired (CPHQ, ISO, Six Sigma)

Quality management experience in a health-related field required

Solutioning and problem-solving experience in utilization and case management programs required

Minimum of 2 years case management experience required

Minimum of 1 year utilization management experience preferred

Experience with commercial health plans and/or clinical programs preferred

Benefits

Benefits are a key component of your rewards package. Our benefits are designed to provide additional protection, security, and support for your career and life away from work. Our benefits include comprehensive health plans, paid time off, retirement savings, corporate wellness, educational assistance, corporate discounts, and more.  

Compensation

The pay range for this position is $(phone number removed)

“Based on our compensation philosophy, an applicant’s placement in the pay range will depend on various considerations, such as years of applicable experience and skill level.”

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