Quality Improvement Manager

Primary Function:

Responsible for the development and management of quality management programs that evaluate and measure the quality of healthcare and service that HealthSpring and its provider?s deliver to members including quality improvement, clinical risk management, accreditation and regulatory compliance and HEDIS.

 

Responsibilities:

?  Develops programs to ensure that HealthSping provides quality healthcare and a high level of service to members.

?  Manages the implementation and evaluation of the Quality Management Program to assure continuous improvement in healthcare and business processes.

?  Assists other functional areas: utilization management, marketing, operations, provider relations, and finance, to identify, measure and improve important business processes.

?  Provides recommendations on the quality management budget and staffing to ensure that the quality management program has adequate resources.

?  Identifies and measures important healthcare processes or health plan populations, coordinates analysis by appropriate health care professionals, and implements actions for improvement.

?  Coordinates and manages the delegation process in compliance with regulatory and accreditation requirements.

?  Manages the accreditation processes for the health plan to ensure compliance with regulatory and accreditation requirements.

?  Coordinates and manages process for HEDIS to assure compliance with regulatory requirements.

?  Assists Medical Director with all Quality Management Committees.

?  Coordinates with the Manager,  Case/Disease Management in the development and implementation of monitoring criteria for Disease Management Programs

?  Coordinates presentation of information on the quality management program to prospective and current customers including HEDIS information.

?  Coordinates with Credentialing and manages the process for Ambulatory Medical Records Review and profiling for recredentialing.

?  Coordinates scheduling of internal Quality Improvement Committee.

?  Develops and monitors processes to assure health plan compliance with HIPAA.

?  Other duties as assigned.

 

Supervisory Responsibilities: 

?  Quality Management Staff

 

 

 

 

Job Related Skills:

?  Understands clinical healthcare processes.

?  Understands continuous quality improvement and provides leadership in quality measurement and improvement as a management process.

?  Possesses excellent written and verbal communication skills.

?  Works well in a team approach and strong interpersonal skills.

?  Ability to use computer applications including spreadsheets, work processing and databases.

?  Ability to analyze data to identify significant trends and opportunities for improvement.

 

Experience:

?  Registered nurse with current license in the State of Tennessee, or an active license in a compact state allowing the multi state privileges to practice in TN.  

?  3-5 years clinical nursing experience.

?  5-7 years experience in quality management in a managed healthcare setting preferred. 

?  1-2 years management experience in healthcare setting preferred.

?  Knowledge of health plan accreditation and regulatory standards preferred.

?  Experience with health plan regulatory reviews and HEDIS preferred.

 

HealthSpring offers a competitive salary and a full range of benefits.

 

TTO APPLY GO TO: www.myhealthspring.com

 

Select Department:  Health Services

Select Position: Quality Improvement Manager

 

Attach resume. Include salary history/requirement. No phone calls accepted.

 

HealthSpring USA, LLC is an EEO/AA employer.