DIRECTOR - QUALITY IMPROVEMENT MANAGEMENT
Company: Network Medical Management Inc
Location: Alhambra
Posted on: January 11, 2021
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Job Description:
SUMMARYLead and develop the Quality Improvement Department and
provide supervision and oversight to all personnel and functions
they perform. The director will oversee the QCI department in
coordinating the HEDIS & Star Quality measures activities and will
work as a liaison with Health Plan's and IPA clients on Quality
Improvement projects.ESSENTIAL DUTIES AND RESPONSIBILITIES include
the following. Other duties may be assigned.* Responsible for the
overall department operations, monitoring and compliance of all
HEDIS & Star Rating activities and performance for all IPAs managed
by NMM* Provide direction and support for all HEDIS related
projects and interventions to include but not limited to medical
record abstraction, aimed at improving HEDIS & Star rating rates*
Facilitate and lead ongoing discussions concerning data
collections, study design, methodology, and data analysis for HEDIS
and Star Measure projects* Lead the department in the development
of new HEDIS interventions and corrective action plans for measures
that fall below health plan benchmark goals* Participate in
strategic planning in anticipating market needs and develop
innovative responses to address future needs and challenges through
planning and management of QCI* Manage relationships with physician
practices* Collaborate with cross functional teams on physician
practice specific strategies to improve overall provider
performance* Oversee the maintenance and update of IPA Provider
Database* Support the providers in preparing infrastructure for
quality management implementation through activities such as
advising on proper documentation, billing and coding, pre-screening
appointments and helping to improve HEDIS scores* Communicates the
vision for change through activities such as presenting best
practices and standards of quality of care with preventive care
program, annual wellness visit, HEDIS, and Star measures*
Facilitate and perform HEDIS & Star Quality Measure trainingsOTHER
DUTIES:* Attend all Health Plan, CMS, DHCS, NCQA, and all other
relevant trainings and technical content webinar training.*
Participate in staff hiring efforts and evaluation of performance
during introductory and annually with Supervisor - QCIT* Attend to
health plans, provider, and interdepartmental calls in accordance
with exceptional customer service; maintain professional and
appropriate behavior (actions/verbal) at all times* Performs other
duties, projects and actions as assigned in a professional manner,
utilizing time and resources efficientlyQUALIFICATIONSTo perform
this job successfully, an individual must be able to perform each
essential duty satisfactorily. The requirements listed below are
representative of the knowledge, skill, and/or ability required.
Reasonable accommodations may be made to enable individuals with
disabilities to perform the essential functions.EDUCATION and/or
EXPERIENCE* Minimum of BA/BS degree* Minimum of 7 years of IPA/MSO
experience required; minimum of 5 years of supervisory/management
experience required* Knowledge of managed care and health plan
standards* Knowledge of NCQA and HEDIS measurements* Experience
with HEDIS technical specifications, standard and non-standard
supplemental data preferred* Experience with Chronic Care Model,
Model of Improvement and general quality improvement methods*
Experience with and understanding of outpatient clinical settings*
Excellent oral and writing skills characterized by the ability to
communicate effectively with varying audiences* Must be detail
oriented and possess strong organizational skills in a fast-pace
environment* Proven PC skills - Excel, Word, Access, Outlook*
Highly motivated and able to work with multiple teams
simultaneously.TRAVELMust be able to travel locally up to 75% of
the time
Keywords: Network Medical Management Inc, Alhambra , DIRECTOR - QUALITY IMPROVEMENT MANAGEMENT, Executive , Alhambra, California
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