Director, Market Quality Improvement(Must Live in Nevada, Preferred Experience In Managed Care)

Job Summary:

The Manager, Market Clinical Quality & Accreditation ensures compliance with external Quality Review audits/studies, Performance Improvement Projects, and Quality Improvement Projects required by the Ohio Department of Medicaid, NCQA, and other accreditation bodies.

Essential Functions:

• Responsible for the review of QI issues regarding compliance with Federal, State, and Accreditation requirements
• Responsible for the annual review, program description, population health strategy plans, and update of QI Department policies and procedures as appropriate
• Review documentation gathered by internal staff and external partners to ensure thoroughness, accuracy and care management competency
• Provide education to internal and external customers on quality improvement functions
• Identify and manage risk, implement mitigation strategies and communicate/escalate to stakeholders
• Build strong working relationships and work cross-functionally to identify process gaps and drive improvements
• Participate in strategic planning and implement action plans
• Assist with the identification of populations, needs, trends and patterns that may impact outcomes, experience and cost of care and prioritization of strategies that drive clinical quality improvement
• Responsible for gathering business intelligence and managing research on a variety of health care related topics
• Collaborate with leadership to evaluate opportunities for HEDIS and process improvement in new or existing projects with focus on measurable benefits
• Lead and conduct business process and gap analysis to diagnose process improvement opportunities and to develop re-usable solutions using principles of process excellence and related tools
• Perform any other job related duties as assigned

Education and Experience:

• Bachelor's Degree in nursing, healthcare or related field or equivalent years of relevant work experience is required
• Master's Degree in Nursing or healthcare related field is preferred
• Minimum of three (3) years of health care delivery and/or payer experience required
• Minimum of one (1) year of experience in data analysis, data reporting, or analytic programming required
• Healthcare experience required
• Experience in quality metrics preferred
• NCQA Accreditation experience 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 and 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

Working Conditions:

• General office environment; may be required to sit or stand for extended periods of time
• Some travel may be required

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:
Salary

Competencies:
- Create an Inclusive Environment
- 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 inclusive environment that welcomes and supports individuals of all backgrounds.

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