Associate Manager, Clinical Quality

Job Summary:

The Associate Manager, Clinical Quality will help our communities thrive by ensuring that the healthcare services provided meet contractual standards of quality. The role is responsible for overseeing a continuous quality improvement program that drives performance across the network. Additionally, this role is responsible for creating and facilitation training strategies/programs to support an operational team responsible for working closely with and understanding the process of abstraction and pursuit of HEDIS® measures to ensure that operational milestones, gap closures, rates, and overall successful quality standards are met.

We are a culture that is unabashedly driven by purpose. We are making a difference to our patients and providers while growing at an accelerated rate. Every day, we support the health journey of patients by authentically living our core values: Purpose Driven, Relationships Matter, Serve Others First, and Inspire Creativity. If you love serving others and would like to make a material difference in an industry-transforming organization, then we invite you to apply to this role. We are recognized as one of the Top 100 Places to Work by The Dallas Morning News, and we have been awarded as one of the fastest-growing privately held companies by SMU Cox.

Role and Responsibilities:

• Works with other departments across the organization to determine ways to support Quality initiatives and work with teams to facilitate and lead HEDIS® training, technical training understanding, and workflow processes.
• Ability to synthesize & utilize data to create quality strategies and develop quality improvement programs, taking into account areas of opportunities.
• Fully own Quality initiatives, receiving assistance from others within the organization as needed.
• Responsible for researching & developing quality improvement programs to provide services that lead to better healthcare outcomes.
• Coordinates & leads organization-wide quality improvement (QI) programs & measures standards of performance.
• Ownership & support of the development of quality improvement in-service education, Continuous Quality Improvement (CQI) training, and training for other programs focused on quality.
• Ownership of the Quality related Committees and other review committees; Analysis of QI data; and supports and facilitates specific QI projects as needed. Supports in implementing policies, procedures and objectives and updates the Institutional Quality Improvement Plan as needed.
• Maintains current working knowledge of URAC, NCQA, CMS, HEDIS and other accreditation and regulatory standards applicable to physician office group practices. Creates and maintains all required documentation related to quality, URAC and other accreditation bodies.
• Maintaining clinical services policies and procedures & workflows related to Quality. This includes coordination of annual review and presentation of changes to committee members.
• Measuring and evaluating data to determine the impact of the quality programs on both program operations and health of patients.
• Compiles data for trend analysis and reporting so quality action plans can be developed and implemented.
• Identify community standards, benchmarks, and best practices and assess company performance to community standards, benchmarks, and best practices to identify improvement opportunities.
• Maintains ownership of the Quality Action Plans and reports back to leadership for feedback and for reporting to the Quality Improvement Committee.
• Monitors that staff comply with the established written policies and procedures around quality and improvement.
• Reviews and integrates medical information from diverse sources including medical records, member documents, and provider offices.
• Provides quality related feedback to Performance Advocate team to share with practitioners.
• Utilize corporate and industry standard tools and techniques to effectively oversee programs according to department procedures.
• Ability to create & manage process improvement resources such as Four blockers.
• Performs other related duties as assigned.

Qualifications and Requirements:

• Active RN nursing license to practice in the state assigned or maintain a compact license preferred.
• Other degrees & clinical licenses & certifications will be considered such as quality, healthcare administration, public health etc.
• Minimum of 2 years' experience in healthcare information collection and data analysis, related to HEDIS, CAHPS, GPRO and other associated data preferred, to support health care improvement activities. CPHQ highly preferred.
• Minimum of two years' experience in a clinical/health care setting, preferably working directly with physician practices and/or patients.
• Strong written, verbal and communication skills a must with a proven ability to positively influence behavior towards a positive outcome.
• Proficiency in computer and software programs (e.g. Microsoft Word, Excel).
• Effectiveness in communication style (written and verbal), with proven ability to positively influence behavior toward a positive outcome.
• Self-motivated with the ability to work independently, as well as within a team environment.
• Ability to adapt and quickly learn electronic programs.
• Positive, service-oriented attitude. High level of integrity.