Quality Improvement - Senior Manager Quality Improvement 195-6000

Tulsa, OK, USA Req #705 Tuesday, November 12, 2024

JOB SUMMARY:

Responsible for managing the operational and strategic aspects of the Company's Quality Improvement department, which includes the QI Program, Star Rating Program, Accreditation, and Clinical Coding and Compliance monitoring.

KEY RESPONSIBILITIES:

• Leads and directs processes and overall quality improvement activities for all beneficiaries.
• Responsible for multiple company work domains, including but not limited to:
  • Quality Improvement activities and interventions - Coordinates and oversees the company's Quality Improvement activities and interventions, including the chronic care improvement and medication therapy management programs. Provides oversight for the companywide annual QI program description, work plan and evaluation.
  • Star Rating Program - Collaborates with stakeholders to develop improvements for the plan's Medicare Star Rating. Coordinates required surveys with external vendors.
  • Accreditation - Coordinates the company's accreditation efforts to maintain certification of Qualified Health Plans.
  • Coding and Compliance – Assists with any compliance activities including external audits from regulators. Oversees chart audits for various coding reviews.
• Provides input to strategic decisions that affect the functional area of responsibility.
• Interfaces regularly with key constituency groups and other stakeholders.
• Oversees departmental administrative functions: planning and implementing company and departmental goals and objectives; hiring, training, and management of staff; and develops/improves systems and process to accomplishing work.
• Coordinates and oversees the activities of the monthly Clinical Quality Improvement and Stars Committee meetings. Participates in other company committee activities as assigned.
• Work involves meeting tight deadlines.
• Perform other duties as assigned.

QUALIFICATIONS:

• Ability to effectively lead and supervise others.
• Ability to reason logically and to use good judgment in interpreting regulatory materials and/or situations.
• Possess strong oral and written communication skills.
• Ability to plan, organize, schedule and affect policy and procedural changes.
• Excellent organizational skills and the ability to perform multiple tasks.
• Superior skills in data analysis and statistical reasoning.
• Ability and proven experience in translating data into actionable goals.
• Proficient in Microsoft applications.
• Active listening and problem-solving skills.
• Excellent time management and documentation skills.
• Ability to write reports, develop programs and give professional presentations when needed.
• Successful completion of Health Care Sanctions background check.

EDUCATION/EXPERIENCE:

• Bachelor's degree or equivalent experience.
• Certified Professional in Healthcare Quality (CPHQ) (Preferred).
• Previous Quality Improvement and Utilization Management experience.
• Current, active, unrestrictive license to practice as Registered Nurse (RN) or Licensed Practical Nurse (LPN) in the State of Oklahoma.
• At least five years of experience in managed care, health insurance and/or health care.
• Previous supervisory or managerial experience required.
• Knowledge and awareness of Community resources.

CommunityCare is an equal opportunity at will employer and does not discriminate against any employee or applicant for employment because of age, race, religion, color, disability, sex, sexual orientation or national origin

Other details

• Job Family Commercial
• Pay Type Salary

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