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Manager, Quality Improvement
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- Duties and Responsibilities Quality Improvement Operations Provide direction and manage HMSA's overarching Quality Improvement program, including the oversight of staff and necessary resources required to design and implement programs related to compliance with accreditation, regulatory and program requirements (e.g., NCQA, Med-QUEST, CMS, OPM, etc
- Manage and direct ongoing assessment of business functions for numerous departments within the scope of NCQA standards (e.g., Provider Services, Utilization Management, Medical Management, Integrated Health Management Services, Customer Relations, etc.)
- Collaborate with cross-departmental teams to identify and implement organization-wide strategic initiatives that support HMSA's quality performance.
- Every three years, serve as HMSA's internal lead for NCQA's re-accreditation review by gathering all necessary documents and information from business areas, managing timely document submissions to NCQA, facilitating NCQA requests for additional information, and coordinating onsite review activities.
- Develop and maintain delegation and contractual language that meets audit specifications and serves the best interest of HMSA's QI program.
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