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Req. No

1854

Job Title

Director of Quality Management

Market

CHRISTUS System Office

Category

Quality and Risk Management

Facility

CHRISTUS Corp Health Plan 919 and 909 Buildings

Address

919 Hidden Ridge
Irving, TX  75038
US

Type

FULL TIME

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Summary:

The Director of Quality Improvement is responsible for daily operations associated with the Quality Improvement Department and is accountable for establishing and implementing an effective quality improvement program essential to meet state, federal and accreditation requirements. The Director is responsible for providing leadership to achieve the above goals as well as best practice performance levels in quality improvement. This role requires that the individual interfaces with a diverse range of clinical and administrative professionals, resolves complex policy and service issues and directs oversight of reporting activities required by regulatory agencies. This position is responsible for identifying and recommending initiatives as a result of evaluation of the health plan's activities and member population need. They include development and monitoring of quality indicators for plan performance, support of the Quality Improvement Committee, and promotion of continuous quality improvement activities within the entire organization.

Responsible for all aspects of the Quality Improvement program for CHRISTUS Health Plan, including such activities as

  • Budgetary responsibility for areas of related to the Quality Improvement Department
  • Identifies need for and leads staff in development and revision of policies and procedures governing Quality Improvement Operations
  • Provides supervision and support to the RN Manager and assures oversight of provider audits, education, associate training and review, work plan development, corrective action oversight, member safety and potential quality of care issue identification and investigation
  • Oversees physician education efforts regarding HEDIS and any other needed education for success. Assures that all education is provided on an ongoing basis and includes the most up to date requirements and/or guidelines, as well as coordination with the Network Management field representatives
  • Responsible for NCQA and URAC or other regulatory agency readiness, accreditation and coordination with accreditation agency. Leads efforts to prepare for audits, which includes departmental education, training/meetings and quality communication
  • Quality Improvement Committee (QIC) participation, which may include being the committee Chair. Assurance that all required business areas are reporting in accordance to the QIC Work Plan.
  • Oversight of HEDIS Improvement initiatives in conjunction with quality HEDIS subject matter expert, data analyst and IT support. Oversight of the HEDIS vendor, audit process, reporting of results to QIC and Board of Directors, comparing results to bench-marking data available, development of improvement activities and implementation of actions to improve.
  • Assures that the annual Clinical Quality Management Program (CQMP) evaluation is complete timely as well as the Quality Program Description and Work Plan
  • Oversight of the Peer Review Process (PRC), communication with external providers as well as Medical Director including coordination of meeting time, oversight of RN PQI investigation and staffing with MD, provider communication and upkeep of log and letter templates. Quarterly reporting to QIC for all PQI's for all LOB's
  • Maintains Quality Improvement Activities (QIA's) and Performance Improvement Plan's (PIP's)
  • Ensures that department priorities are aligned with Senior Leadership by meeting regularly with Business Unit leaders through the free and open exchange of information.
  • Oversees quality contribution to member and physician education to include research and development and review of written material.
  • Participates in appointed committees and sub-committee's as well as update inter-departmental structures as well as committee structure as needed
  • Follow the CHRISTUS guidelines related to the Health Insurance Portability and Accountability Act (HIPAA), designed to prevent or detect unauthorized disclosure of Protected Health Information (PHI).

Requirements:

  • Bachelor Degree. Master's degree in Health Care Management preferred
  • Excellent knowledge of accrediting standards relating to managed care operations/health plans
  • Solid background in facilitation skills, process analysis tools and quality theories
  • Strong interpersonal skills, including the ability to interact effectively with staff, employees, supervisors, managers, physicians, and hospital executives
  • Effective verbal and written communications, and organizational skills
  • Knowledge of computer systems and QI applications
  • Ability to work collaboratively and effectively in intense environment
  • Excellent speaking ability, judgment, initiative and problem solving abilities
  • Considerable discretionary decision making
  • Ability to handle and resolve complex issues
  • Ability to work a flexible work schedule
  • Meeting deadlines in high pressure environment
  • High degree of personal accountability and integrity demonstrated
  • Occasional Regional travel as necessary to achieve job responsibilities and strategic objectives.
  • Long term project management skills
  • Analytic ability to prepare status reports and document procedures
  • Minimum five years quality management experience in the Health Care field
  • Minimum five years of experience in Quality Improvement within a health plan
  • Minimum five years of experience in leading effective HEDIS programs and accreditation
  • Minimum five years of managed care experience
  • Minimum of 4+ years of management experience
  • Knowledge and experience regarding HEDIS, NCQA, URAC, QIC facilitation, Peer Review Committee oversight and regulatory

Work Type: 

Full Time


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