Responsibilities:

As part of the Quality Management team, the Supervisor, Quality Management leads the day-to-day execution of the following functional areas: Quality Management objectives/initiatives; HEDIS; Reporting and Analysis. These areas include the delivery of performance improvement projects for service and clinical activities, integrating the quality improvement plan into all departments and facilitating HEDIS, CAHPS and NCQA accreditation activities, supporting the overall implementation of Quality Management programs. This position will work in a collaborative manner with all providers, members, departments within AmeriHealth Caritas to conduct ongoing process and data review to identify opportunities for improvement.

This position is also responsible for managing and developing a team of non-clinical and clinical quality performance to support these areas of responsibility:

Quality Improvement:

• Responsible for the oversight, design, and implementation of Quality projects and ensuring identification of root cause, and with the assistance of the Manager, Quality Management, establishing a work plan to implement interventions.
• Leads Quality Performance Specialists, Clinical and non-clinical, in the implementation of interventions aimed at improving quality performance.
• Acts as liaison to Quality Management staff and represents in committees and workgroups whose focus is quality improvement projects.
• Uses data and analysis tools to identify opportunities for improved performance and collaborates with peers to develop intervention strategies.
• Removes barriers to achieve successful completion of strategic projects.
• Conducts analysis and provides summary reports and analysis to senior management.
• Executes on organizational efforts in ongoing quality improvement processes to ensure compliance with State, Federal, regulatory and accrediting body’s standard requirements.
• Responsible for completion and analysis of annual HEDIS results and works with all areas to integrate results into departmental goals.
• Responsible for the successful development and evaluation of an annual QI work plan and program description by facilitating QI throughout the organization.
• Identifies resolves and/or escalates problematic QI areas that may place Plan at risk of not achieving annual goals.
• Collaborates with Provider Services and Member Services to complete analysis of annual satisfaction surveys and works with all areas to integrate results into departmental goals.
• Participates in the development, implementation and maintenance of QI policies and procedures.
• Works professionally and efficiently with all functional areas in meeting organizational and departmental quality goals.
• Participates on QI committees structured to achieve outcomes success and completes committee documentation that is consistent in meeting regulatory and accrediting body requirements.

Accreditation & Reporting and Analysis:

• Responsible for the NCQA accreditation related reporting and analysis activities to include: production of reports and analysis to support executive leadership decision making; QM Department data collection and analysis activities that support accreditation compliance, based on guidance from the Accreditation department.
• Leads Quality Performance Specialist responsible for QI data reporting and accreditation required projects.
• Supervises the processes for calendars, agendas, minutes and accreditation compliant documentation for all Committees that are part of the QM Committee structure, and assures timely and accurate preparation of QM Documentation.

General:

• Performs ad-hoc analysis of any underperforming or “broken” processes by collaborating with Subject Matter Experts to define existing processes and make recommendations for improvement.
• Responsible for the management and development of new and existing staff in a remote work setting.

Education/ Experience:

• Bachelor’s Degree or equivalent work experience required.
• Three to five (3 to 5) years of supervisory or leadership responsibilities in Quality Improvement.

Other Skills:

• Demonstrated ability to manage staff.
• Excellent organizational, analytical, and interpersonal skills.
• Excellent written and verbal communication skills.
• Ability to work successfully within all levels of the organization and with Enterprise partners.
• Ability to design, develop and implement projects to address financial, quality and service improvements.
• Proficient PC skills in a windows based environment.