Manager, Market Quality Improvement - Must Reside in Georgia

Job Summary: The Manager, Market Quality Improvement manages the day-to-day prioritization of staff activities in collaboration with Director, Quality Improvement. The Manager will be responsible for developing quality documents in compliance with state and federal requirements and work with departments outside of quality to obtain information for reports. Essential Functions: Responsible for Corporate oversight of the HEDIS Medical Record Review Unit as needed for the assigned market Responsible for development and oversight of Quality Improvement (QI) Projects and Performance Improvement Projects related to HEDIS and pay for performance (P4P) requirements Ensures compliance with External Quality Review audits/studies, Performance Improvement Projects, and Quality Improvement Projects required by the state, NCQA, and other accreditation bodies Responsible for the review of QI issues regarding compliance with Federal, State, and Accreditation requirements Ensure all policies and procedures are aligned with Federal, State, and Accreditation requirements Responsible for the annual review, program description, program plan, and update of QI Department policies and procedures Provide education to internal and external customers on quality improvement functions Respond to questions that pertain to HEDIS and Quality Improvement from providers and internal staff members Foster relationships with all internal departments and represents CareSource to community-based and state programs Collaborate with business owners to establish, implement, and develop best practices for P4P quality directives Implement opportunities for process improvement that impact quality measurements in assigned market Monitor industry trends as it relates to healthcare and identify areas of opportunity for improvement Responsible for ensuring business owners successfully complete all deliverables related to performance improvement plans (PIPs) and quality improvement plans (QIPs) within defined timeframes Conducts analysis, including root cause analyses with support from identified business units and ensure data is presented and used efficiently to meet the quality goals Follows enterprise standards and procedures for all quality reporting and documentation and communicate areas of strengths as well as needs to the Quality Improvement Committee Perform all facets of quality management to include the development of detail work plans, setting deadlines, assigning responsibilities and monitoring/summarizing project progress Establish, monitor and review mechanisms to assess and document each business units level of compliance with each measure and coordinate corrective actions Attends and participates in market quality committees Guide and direct successful completion of daily tasks and projects Interview, select and train new team members Conduct performance management activities for direct reports, to include monthly one-on-one meetings, annual performance appraisals, and discipline as appropriate Perform any other job related instructions, as requested Education and Experience: Bachelor’s Degree or equivalent years of relevant work experience is required Completion of an accredited Registered Nursing degree program or Bachelor’s of Science in Nursing (BSN) is preferred Master’s Degree in Nursing (MSN), Public Health, or healthcare related field is preferred A minimum of three (3) years of experience in a healthcare or managed care organization is required Previous management experience is required Medicaid and/or Medicare experience preferred Experience in quality metrics preferred Competencies, Knowledge and Skills: Intermediate proficiency in Microsoft Word, Excel and PowerPoint Solid leadership skills; able to effectively manage a high performing team, provide coaching and development Demonstrated ability to adjust and shift priorities, multi-task, work under pressure and meet deadlines Proven ability to recognize opportunity for improvement and lead change Data analysis and trending skills Effective communication skills Prior supervisory skills Ability to work independently & in a team environment Training/teaching skills Time management skills Critical listening and thinking skills Strategic management skills Decision making/problem solving skills Customer service oriented Licensure and Certification: Current, unrestricted Registered Nurse (RN) licensure in the state of practice is preferred Certified Professional in Healthcare Quality (CPHG) is preferred Working Conditions: General office environment; may be required to sit/stand for long periods of time Some in state travel required (approximately 20% of time) Compensation Range: $81,400.00 - $130,200.00 CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package. Compensation Type (hourly/salary): Salary Organization Level Competencies Fostering a Collaborative Workplace Culture Cultivate Partnerships Develop Self and Others Drive Execution Influence Others Pursue Personal Excellence Understand the Business This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds. #LI-JM1 The CareSource mission is known as our heartbeat. Just as we support our members to be the best version of themselves, our employees are driven by our mission to create a better world for members, stakeholders and providers. We are difference-makers who combine compassionate hearts with our unique business expertise to make every opportunity count. Each claim, each phone call, each consumer-centric decision is a chance to change the world for one member, and our employees look for ways to do that every day. The challenge is, there is no one right way to be the difference and we’re looking for people like you that will rewrite that definition every day. We do what it takes to form creative solutions that make our community and the world just a little better. Discover what it means to be #UniquelyCareSource.

Salary : $81,400 - $130,200