DIRECTOR - QUALITY IMPROVEMENT MANAGEMENT

Company: Network Medical Management Inc
Location: Alhambra
Posted on: January 11, 2021

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