REMOTE - Manager, Market Quality Improvement - Must Reside in Georgia - R11080-1

CareSource is a healthcare organization, and they are seeking a Manager for Market Quality Improvement. The Manager will oversee quality improvement projects, ensure compliance with regulations, and foster collaboration across departments to enhance healthcare quality in the assigned market.

Responsibilities:

• Responsible for Corporate oversight of the HEDIS Medical Record Review Unit as needed for the assigned market
• Responsible for development and oversight of Quality Improvement (QI) Projects and Performance Improvement Projects related to HEDIS and pay for performance (P4P) requirements
• Ensures compliance with External Quality Review audits/studies, Performance Improvement Projects, and Quality Improvement Projects required by the state, NCQA, and other accreditation bodies
• Responsible for the review of QI issues regarding compliance with Federal, State, and Accreditation requirements
• Ensure all policies and procedures are aligned with Federal, State, and Accreditation requirements
• Responsible for the annual review, program description, program plan, and update of QI Department policies and procedures
• Provide education to internal and external customers on quality improvement functions
• Respond to questions that pertain to HEDIS and Quality Improvement from providers and internal staff members
• Foster relationships with all internal departments and represents CareSource to community-based and state programs
• Collaborate with business owners to establish, implement, and develop best practices for P4P quality directives
• Implement opportunities for process improvement that impact quality measurements in assigned market
• Monitor industry trends as it relates to healthcare and identify areas of opportunity for improvement
• Responsible for ensuring business owners successfully complete all deliverables related to performance improvement plans (PIPs) and quality improvement plans (QIPs) within defined timeframes
• Conducts analysis, including root cause analyses with support from identified business units and ensure data is presented and used efficiently to meet the quality goals
• Follows enterprise standards and procedures for all quality reporting and documentation and communicate areas of strengths as well as needs to the Quality Improvement Committee
• Perform all facets of quality management to include the development of detail work plans, setting deadlines, assigning responsibilities and monitoring/summarizing project progress
• Establish, monitor and review mechanisms to assess and document each business units level of compliance with each measure and coordinate corrective actions
• Attends and participates in market quality committees
• Guide and direct successful completion of daily tasks and projects
• Interview, select and train new team members
• Conduct performance management activities for direct reports, to include monthly one-on-one meetings, annual performance appraisals, and discipline as appropriate
• Perform any other job related instructions, as requested

Requirements:

• Bachelor's Degree or equivalent years of relevant work experience
• A minimum of three (3) years of experience in a healthcare or managed care organization
• Previous management experience
• Intermediate proficiency in Microsoft Word, Excel and PowerPoint
• Solid leadership skills; able to effectively manage a high performing team, provide coaching and development
• Demonstrated ability to adjust and shift priorities, multi-task, work under pressure and meet deadlines
• Proven ability to recognize opportunity for improvement and lead change
• Data analysis and trending skills
• Effective communication skills
• Prior supervisory skills
• Ability to work independently & in a team environment
• Training/teaching skills
• Time management skills
• Critical listening and thinking skills
• Strategic management skills
• Decision making/problem solving skills
• Customer service oriented
• Completion of an accredited Registered Nursing degree program or Bachelor's of Science in Nursing (BSN)
• Master's Degree in Nursing (MSN), Public Health, or healthcare related field
• Medicaid and/or Medicare experience
• Experience in quality metrics
• Current, unrestricted Registered Nurse (RN) licensure in the state of practice
• Certified Professional in Healthcare Quality (CPHG)