Manager, Quality-SECUR Healthplan

It’s inspiring to work with a company where people truly BELIEVE in what they’re doing!

When you become part of the CareNu Team, you’ll realize it’s more than a job. It’s a mission. We’re committed to providing groundbreaking solutions for our clients' unique needs offering a wide variety of compassionate healthcare choices. Our employees make all the difference in our success!

Role:
The Medicare Advantage Quality Coordinator supports assigned practices in activities to improve quality and Star Rating performance for Medicare Advantage programs.
**This is a hybrid role that requires 3-4 days in the corporate office/week**

Qualifications:

• Bachelor’s degree in science, nursing, Public Health, Health Administration or directly related field.
• Three to five years of managed care experience or related experience.
• Three years of experience in Quality Improvement or Quality Management.
• Required knowledge of NCQA standards.
• Required knowledge of health plan performance and HEDIS, HOS, CAHPS and CMS Stars measures.
• Intermediate knowledge of state and federal laws and resources.
• Ability to effectively communicate in English, both verbally and in writing.
• Strong written, verbal, and interpersonal communication skills.
• Proficiency in analytics and report writing.
• Ability to work in a fast-paced environment with changing priorities.
• Ability to effectively present information and respond to questions from peers, management, members, providers, and other stakeholders.
• Knowledge of healthcare delivery.
• Ability to lead/manage others.

Job Responsibilities:

• Plans, organizes and directs the staff and activities of the Quality Management/Performance Improvement to achieve approved clinical goals and strategic operating plans and objectives.
• Ensures compliance with regulatory agencies in accordance with internal and external requirements/regulations. Promotes effective patient safety and performance improvement initiatives to improve processes and outcomes of patient care.
• Develop a conceptual framework for quality measurement and improvement activities, including development, monitoring, and reporting on Chronic Condition Improvement Plans.
• Summarize findings in the annual Quality Improvement (QI) Plan.
• Work with CEO, COO, CFO, CMO, Medical Director9s), and members of Management to develop and ensure the implementation of policies to minimize risk within the organization.
• Manage and oversee Clinical Coordinators, Population Health Specialist and Care Coordinators.
• Manage and implement the requirements for SECUR’s I-SNP Model of Care, Section 4 governing performance improvement and evaluation.
• Coordinate with the Data Analyst to develop audit systems, perform data analysis and prepare reports related to measuring objectives and tracking outcomes as required by CMS regulatory requirements.
• Analyze and report data, as required, with the QI Reporting calendar and for continued recognition through NCQA, CAHPS and HOS activities, as applicable.
• Coordinate with the CMO and Medical Director(s), and Management members to organize and lead chronic disease care improvement efforts.
• Lead the monthly Quality Improvement Workgroup.
• Lead the quarterly Quality Improvement Committee reports to the Board.
• Work with Medical Director(s) and CMO to monitor and track organizational performance as it relates to meeting CMS standards.
• Mentor new quality improvement staff.
• Oversight of all quality-of-care grievances and other issues referred to the Quality Department for investigation.
• Reporting on key performance indicators (KPIs), including updates on Star measure performance.

Competencies:

• Satisfactorily complete competency requirements for this position.

Responsibilities of all employees:

• Represent the Company professionally at all times through care delivered and/or services provided to all clients.
• Comply with all State, federal and local government regulations, maintaining a strong position against fraud and abuse.
• Comply with Company policies, procedures and standard practices.
• Observe the Company's health, safety and security practices.
• Maintain the confidentiality of patients, families, colleagues and other sensitive situations within the Company.
• Use resources in a fiscally responsible manner.
• Promote the Company through participation in community and professional organizations.
• Participate proactively in improving performance at the organizational, departmental, and individual levels.
• Improve own professional knowledge and skill level.
• Advanced electronic media skills.
• Support Company research and educational activities.
• Share expertise with co-workers both formally and informally.
• Participate in Quality Assessment and Performance Improvement activities as appropriate for the position.

Leadership Success Factors:

• Communication.  Express thoughts and ideas clearly.  Adapt communication style to fit audience.
• Initiative.  Originate action to achieve goals.
• Management Identification.  Identify with and accept the problems and responsibilities of management.
• Judgment.  Make realistic decisions based on logical assumptions, information and in consideration of organizational resources.
• Planning, Organizing and Controlling.  Establish course of action for self and/or others to accomplish a specific goal; plan proper assignments of personnel and appropriate allocation of resources.  Monitor results.
• Leadership.  Use appropriate interpersonal styles and methods in guiding others.

• Ethics.  Model highest standards of conduct and ethical behavior, adopting a strong position against fraud and abuse.
• Regulatory Compliance:  Educate and monitor staff regarding their own and the Organization's responsibilities for regulatory compliance.

This position requires consent to drug and/or alcohol testing after a conditional offer of employment is made, as well as on-going compliance with the Drug-Free Workplace Policy.