Director Of Quality Improvement

Job Description
Title: Director of Quality Improvement
Compensation: $153,597 – $199,676
Description: Under the direction of the Chief Medical Officer and the Administrative Director of Health Services, the Director of Quality Improvement will oversee and participate in activities related to Quality Improvement for the organization and membership by monitoring, assessing and improving performance in ambulatory and inpatient health care delivery or health care related services. The Director will implement the Quality Management Plan and communicate with contract providers regarding required studies and participation. Related duties will include ongoing data collection, medical record reviews, report writing, and collaboration and coordination with other departments, as well as outside agencies.
This position is responsible for Quality Improvement, HEDIS reporting, health education and disease management functions. This professional will be responsible for ensuring compliance with the QI work plan, oversight of the design, implementation, analysis and dissemination of utilization and accessibility studies and member and provider satisfaction studies. The Director of QI will also be responsible for overseeing the production, analysis, and dissemination of contractually mandated reports. The Director of QI is also responsible for maintaining compliance with Medi-Cal contractual stipulations for Quality programs. Makes an effective contribution to business planning and fiscal processes.
What You Will Do:

• Designs and implements Quality Improvement programs that meet organizations goals and complies with regulatory, contractual, and NCQA requirements.
• Maintains responsibility for all activities of the Quality Improvement staff including policies, procedures, and operations.
• Works in coordination with the Provider Relations Manager of Special Programs to develop grant programs
• Maintains overall direction and supervision for all ongoing and new projects for the QI program.
• Provides leadership and support to QI staff involved in QI projects.
• Annually updates QI policies and procedures with input from the Quality Improvement Committee.
• Participates as an active member of plan committees requiring preparation, research, and follow-up as requested by the Chief Medical Officer.
• Oversees credentialing processes and all HEDIS related activities.
• Supervises quality of care investigations and reporting.
• Represents the organization as the QI liaison for external subcommittees, behavioral health subcontractor, QI workgroups, etc.
• Assists with interviews, selects, trains, develops, and evaluates subordinate staff; provides input to Human Resources regarding disciplinary issues, as required.
• Coordinates QI activities and data collection between departments and contracted providers.
• Prepares the organization for review and the accreditation processes by monitoring of external contract providers and internal processes.
• Contributes to the overall design of the Pay for Performance Incentive Program in collaboration with Provider Relations department.
• Coordinates and conducts in-depth chart analysis, data collection, and report preparation.
• Summarizes information collected for identification of patterns, trends, and individual cases requiring intensive review.
• Identifies and recommends the initiation of Quality Improvement studies related to multi-disciplinary quality issues and State required studies
• Designs and maintains monitoring systems for the collection of HEDIS data.
• Develops targeted interventions to improve HEDIS results and QI initiative results.
• Serves as staff support and resource to the Quality Improvement and Utilization Management Committee, the Physician Advisory Committee, and others
• Assists in problem identification, data analysis, conclusions, recommendation, action- plan design, follow-up and tracking.
• Implements and facilitates internal Quality Improvement studies and work groups for continuous improvement within the organization.
• Performs other job-related duties as required.
• Adheres to all company policies and procedures relative to employment and job responsibilities.

What You Will Bring:

• RN License for California
• Master's degree in nursing Required
• 3+ years of experience in Quality Improvement program implementation, research design, data collection, medical record abstraction, and quantitative analysis of health data.
• 3+ years of experience in NCQA accreditation process and program management experience
• 5+ years of experience in managed care systems in a health maintenance organization (HMO)

About Impresiv Health:
Impresiv Health is a healthcare consulting partner specializing in clinical & operations management, enterprise project management, professional services, and software consulting services. We help our clients increase operational efficiency by delivering innovative solutions to solve their most complex business challenges.
Our approach is and has always been simple. First, think and act like the customers who need us, and most importantly, deliver what larger organizations cannot do – provide tangible results that add immediate value, at a rate that cannot be beaten. Your success matters, and we know it.
That's Impresiv!