Job Description:

The Manager, Quality Improvement plays a pivotal role in the organization's efforts to improve patient care, safety, and outcomes. The primary focus of this role is to identify areas for improvement, implement changes, and monitor progress to ensure that quality standards are met or exceeded.

Eligibility
A minimum of 3 years previous experience with Quality, National Committee on Quality Assurance (NCQA), Healthcare Effectiveness Data Information Set (HEDIS), Star Rating, and Pharmacy Quality Alliance (PQA).

Responsibilities

• Commitment to the principles of continuous quality improvement
• Evaluate and continuously review existing procedures to identify areas that require enhancement
• Compare performance and quality metrics to industry benchmarks
• Project manage improvement plans and strategies, including but not limited to root cause analysis, corrective action plans, objectives, actions, timelines, status and performance
• Collaborate with teams across departments to align and share accountability with quality improvement efforts with organizational goals, including Coding and Utilization
• Ensure compliance with CMS, NCQA, HEDIS, PQA, and other industry regulations and standards
• Lead and foster relationships with internal and external stakeholders and payors
• Utilize statistical tools and techniques to identify trends and drive goal achievement
• Provide expertise in education, training, and support to staff in the development of quality knowledge, initiatives, and skills while ensuring understanding of objectives and method
• Validate data submission, including but not limited to visit note documentation and coding
• Partner with EMR standard supplemental data and Admission, Discharge, Transfer feeds
• Prepare regular KPI and KAI reports and presentations on work function activities for management
• Incorporate provider and patient feedback into improvement strategies for development of education materials and tools
• Manage audit operations ensuring effective performance with Quality measures such as correct template usage, blood pressure recheck, point-of-care testing, attestation completion
• Facilitate the development and updates of Standard Operating Procedures and guidelines
• Plan and monitor outreach to meet Annual Wellness Visit, Annual Physical Exam, and Transition of Care visit goals
• Create and evaluate campaigns for patient engagement and goal achievement
• Oversee data collection, integration with dashboard and scorecard display
• Monitor and analyze costs and participate in the preparation of the budget
• Partner on Patient Experience initiatives and monitoring
• Complete additional tasks and duties as assigned

Requirements/Skills

• Bachelor’s degree in healthcare administration or a related field
• 3 years of experience in HEDIS, quality or a related field
• 2 years of experience in Primary Care/Medical Group
• Excellent interpersonal and leadership skills
• Ability to manage competing priorities and needs of multiple stakeholders
• Knowledge of healthcare regulations and best practices
• Ability to motivate others, individual, and groups
• Strong critical thinking and problem-solving
• Ability to analyze, develop and present high level analysis and metrics
• Ability to foster a healthy work culture and to work alone or in a team
• Capability to work in a fast-paced environment and adapt to new policies or workflows
• Ability to maintain patient confidentiality
• Proficiency in Microsoft Office (Excel, Word, Outlook) and electronic medical records
• Medical Assistant Certification preferred

Reports to: Senior Director, Quality Improvement

Disclaimer: This description is intended to provide only basic guidelines for meeting job requirements. Responsibilities, knowledge, skills, abilities and working conditions may change as needs evolve.

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Job Type: Full-time

Pay: $57,000.00 - $80,000.00 per year

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Health insurance
• Life insurance
• Paid time off
• Referral program
• Vision insurance

Schedule:

• 8 hour shift
• Day shift
• Monday to Friday

Education:

• Bachelor's (Required)

Experience:

• Quality improvement: 3 years (Required)
• NCQA standards: 3 years (Required)
• HEDIS: 3 years (Required)
• PQA: 3 years (Required)
• Star Rating: 3 years (Required)
• Primary Care/Medical Group: 2 years (Required)

Ability to Relocate:

• Las Vegas, NV: Relocate before starting work (Required)

Work Location: In person