Manager, Quality Improvement 41148

SUMMARY:
Perform duties to oversee and manage the functions of the quality improvement program for the assigned state providing support to staff and communicating with department and plan administrative staff to facilitate daily department functions.

Leadership: Manage and coordinate activities of the assigned work function and or department. Assign or delegate responsibilities for specific work or functional activities. Give work directions resolve problems prepare schedules and set performance expectations and deadlines to ensure timely completion of work. Coordinate activities of assigned work function and or department with related activities of other work functions and or departments to ensure efficiency and economy.
Report Preparation: Review and analyze reports records and directives and confer with staff to obtain data required for planning work function activities such as new projects status of work in progress and problems encountered. Also to verify data to be submitted in accordance with state Medicaid program requirements and to ensure compliance with Company Federal State Health Plan Employer Data and Information Set HEDIS National Committee on Quality Assurance NCQA and or Joint Commission on Accreditation of Healthcare Organization JCAHO standards. Prepare reports and records on work function activities for management using computer.

Methods and Procedures: Evaluate current procedures and practices for accomplishing the assigned work function’s objectives to develop and implement improved procedures and practices and to ensure compliance with Company Federal State National Committee on Quality Assurance NCQA and or Joint Commission on Accreditation of Healthcare Organization JCAHO standards.

Customer Service: Collaborate with appropriate departments to document investigate and resolve formal informal complaints and appeals in accordance with Company and State policies procedures and requirements

Annual Budgeting: Monitor and analyze costs and participate in the preparation of the budget using computer. People Development: Initiate and participate in the hiring of staff promotions discharges and transfers. Train and supervise staff.

Typical Duties: Participate in attend and plan coordinate as necessary staff departmental committee sub-committee State and other activities meetings and seminars.

REQUIREMENTS:
RN and CPHQ Certified Professional in Health Care.
3 – 5 years nursing experience.
1 – 3 years recent quality improvement and management experience in a healthcare environment preferably managed care.