Manager, Quality (Rn), Hybrid

Manager, Quality (RN), Hybrid

Purpose Statement / Position Summary

The Quality Manager position is designed to provide, manage, and document continuous activities that identify, evaluates, and improves the quality and safety of care and services provided to all MemorialCare Select Health Plan members. This individual will also be responsible for the ongoing monitoring and analysis of organizational performance, to assist in the design and implementation of quality improvement initiatives in support of the strategic objectives of the organization.

Essential Functions and Responsibilities of the Job

• Responsible for management of the QM staff, which includes a Health Educator, QA Coordinator, and Credentialing Coordinator
• Responsible for the development, implementation and evaluation of the QM Program and Work Plan.
• Oversees the credentialing process to ascertain that MemorialCare Select Health Plan's contracted Providers are properly trained, licensed and certified to provide safe, competent care to members
• Oversees health promotion and quality initiatives
• Organizes and maintains filing systems and archival records
• Responsible for the operational execution of the QM Program under the direction of the Director of Medical Management and Chief Medical Officer
• Has the ability to prioritize and multitask.
• Educate primary care providers on clinical and preventative health guidelines, documentation standards, and coding for outcome reporting
• Works closely with the Credentialing Verification Organization (CVO) on behalf of health plan
• Responsible for the operations of all QM activities for MemorialCare Select Health Plan, including monitoring and reporting as required by regulation or contract.
• Follows company policies, procedures and directives.
• Develops Policies and Procedures, workflows and required documents to meet federal and state regulatory requirements, as needed in focus area
• Ensures gap reports and educational materials are available to Providers
• Reviews medical records to determine completeness and accuracy of potential quality of care issues for further action and investigation according to specific process
• Communicates effectively with a professional attitude.

Pay Range: $102,960.00- $154,460.80

Placement in the pay range is based on multiple factors including, but not limited to, relevant years of experience and qualifications. In addition to base pay, there may be additional compensation available for this role, including but not limited to, shift differentials, extra shift incentives, and bonus opportunities. Health and wellness is our passion at MemorialCare—that includes taking good care of employees and their dependents. We offer high quality health insurance plan options, so you can select the best choice for your family. And there’s more...Check out our MemorialCare Benefits for more information about our Benefits and Rewards.

Essential Job Outcomes

• Responsible for review, updates, and development of MemorialCare Select Health Plan Quality and Credentialing Policies and Procedures
• Oversees regulatory compliance as it pertains to quality and safety
• Identifies, reviews, analyzes, and tracks PQIs, sentinel events, and unintended outcomes
• Reports QM activities to the Quality Council
• Participates in other Organizational Committees, providing agenda items, PowerPoint slides, and presenting information as the subject matter expertise
• Responsible for the operational execution of the QM Program
• Acts as educator and resource to all departments in matters of health care quality
• Manages and provides support for the Credentialing Coordinator
• Co-chairs the Quality Committee
• Responsible for the development, implementation and evaluation of the QM Work Plan
• Responsible for the management of staff assigned to QM activities for MemorialCare Select Health Plan, including monitoring and reporting as required by regulation or contract
• Oversees elements of Health Education Program

Experience

• 2-3 years experience in acute care setting preferred
• 2-3 years experience in a supervisory or management role
• 3-5 years experience in a managed health care environment; Health Plan, IPA, MSO preferred

Education

• Certification in Quality Management a plus (CPHQ, HCQM)
• Current California RN license without restrictions
• Bachelor’s degree required, Advanced degree a plus (MSN, MHA, MPH)