Manager, Healthcare Quality Project Management

Role Overview

• The Manager Health Care, Quality Project Management leads cross-functional activities throughout the health plan to address CAHPs and BH survey responses and ensure effective implementation of these activities to gain positive outcomes.
• Facilitate collaborative partnerships with different departments to meet NCQA standards while monitoring for state requirements as they align with Health Plan goals of maintaining and sustaining accreditation status, as well as looking to advance the Health Plan for other accreditation opportunities.
• Must have knowledge of how population health is integrated throughout the plan and will support program creation.
• Accountable for NCQA and state projects and initiatives through direction setting and leadership
• Develops readiness assessment schedules, conducts in house audits regularly, and ensures changes to the standards are incorporated
• Collaborates with business leads to identify variances and areas for improvements and implements project plans to ensure resolution and compliance to NCQA standards
• Schedules and conducts NCQA work group meetings to produce and develop the QAPI work plan, evaluation and programs
• Facilitate ongoing annual qualitative and quantitative analyses, assuring business owners are taking action on their opportunities for improvement
• Assists in quality improvement initiatives related to accreditation, including but not limited to the engineering of operational processes to improve efficiencies and achieve continuous quality improvement
• Trains and onboards staff and business leads on NCQA standards, and ongoing to ensure their continuing understanding of requirements
• Manages CAHPS and provider satisfaction surveys
• Creates and identifies work groups to address and develop action items based on CAHPS, Behavioral Health satisfaction surveys and provider satisfaction results including monitoring of implementation of actionable items within the plan
• Coordinates QMOC, QMC and UMC
• Oversees maintenance of MHC distinction award and/or other accreditations
• Performs regular audits of website, member handbooks, provider manuals and newsletters for NCQA compliance

Requirements

• 5+ years experience in a project management role
• 3 years experience working in the Health Care Insurance Industry
• Must have experience and full understanding and of the National Committee for Quality Assurance (NCQA) standards
• Must be proficient in all Microsoft office Suite, especially Microsoft Excel.
• Must be analytical and able to interpret data
• Must be articulate and able to communicate to multiple internal and external stakeholders.
• Must have experience in leading an organization through accreditation
• Must be a proficient writer an possess an innate ability to communicate effectively written and orally.
• CPHQ certified or PMP certified

Tech Stack

• PMP

Benefits

• medical, dental, and vision coverage
• paid time off
• retirement savings options
• wellness programs