Job description

Position Summary:

The Quality Manager (QM) is responsible for the planning, organization, and successful execution of one or more quality programs for the Market Region. The Program consists of the CMS STARS and ACO REACH Programs. The QM is responsible for the motivation of the local partnership provider quality teams to achieve measurable gains within the program, as measured by internal and external metrics. Ensures the quality and timeliness of work performed, supervises, and assists in the gathering of data (supplemental or otherwise) and the accurate entry into all systems and subsystems. Demonstrates the ability to work on multiple, complex projects and manages communication between partner quality staff, providers, health plans, market leadership and enterprise.

Essential Job Functions:

• Build relationships and motivate anchor partner quality staff to achieve long- range operational goals.
• Coordinate resources required to meet the business objectives. Manage the resolution of problems that are escalated.
• Continually review and evaluate the progress and performance of STARs and ACO REACH metrics and design developmental programs tailored to meet goals.
• Establish yearly goals and detailed quality plan to meet those goals in collaboration with the anchor partner, market leadership and enterprise leadership.
• Continually assess potential project risks. Creates and implements corrective action plans and develops new procedures resulting in meeting goals.
• Initiates new programs, enhances existing programs and continuously assesses need for resources, tools and add-ons.
• Provides excellent and comprehensive communication and education to internal and external teams. Assists with Provider, staff and member training.
• May coordinate and oversee annual chart audit collection and health plan chart requests. Assists with member and provider communication as needed.
• Produces accurate metrics reports and/or board meeting requests in a timely manner. Identifies areas that need improvement and initiates creative solutions (cost effective) to correct issues to meet and exceed our stated goals.

Other Job Functions:

• Understand, adhere to, and implement the Company’s policies and procedures.
• Provide excellent customer services skills, including consistently displaying awareness and sensitivity to the needs of internal and/or external clients. Proactively ensuring that these needs are met or exceeded.
• Take personal responsibility for personal growth including acquiring new skills, knowledge, and information.
• Engage in excellent communication which includes listening attentively and speaking professionally.
• Set and complete challenging goals.
• Demonstrate attention to detail and accuracy in work product.

Required Qualifications:

Minimum Experience

• 5 or more years’ experience in process management, and HEDIS/STAR experience.
• Experience in Quality initiatives and metrics performance.
• Must demonstrate good written and verbal communication skills.
• Must demonstrate proficient computer skills. Previous EMR experience is preferred and Excel experience is a must.
• Five or more years’ experience in project coordination or management of small, medium and large projects desired.

Education/Licensure:

• Bachelor’s Degree with emphasis in business administration or Health care preferred or equivalent experience.

Job Type: Full-time

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Flexible schedule
• Flexible spending account
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Parental leave
• Professional development assistance
• Referral program
• Retirement plan
• Tuition reimbursement
• Vision insurance

Schedule:

• Monday to Friday

Supplemental pay types:

• Signing bonus

Ability to commute/relocate:

• Bingham Farms Southfield, MI 48025: Reliably commute or planning to relocate before starting work (Required)

Experience:

• Process management: 5 years (Required)
• Quality management: 3 years (Required)
• EMR systems: 1 year (Required)
• Project management: 5 years (Required)
• HEDIS: 5 years (Required)

Work Location: Hybrid remote in Bingham Farms Southfield, MI 48025

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