Manager, Market Quality Improvement - Must Reside in Georgia

Job Summary :

The Manager, Market Quality Improvement manages the day-to-day prioritization of staff activities in collaboration with Director, Quality Improvement. The Manager will be responsible for developing quality documents in compliance with state and federal requirements and work with departments outside of quality to obtain information for reports.

Essential Functions :

• 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

Education and Experience :

Competencies, Knowledge and Skills :

Licensure and Certification :

Working Conditions :

Compensation Range :

$81,400.00 - $130,200.00 CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type : Salary

Competencies :

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.

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