Manager, Quality and Performance Improvement
Job Summary The Manager, Quality and Performance Improvement is responsible for managing the development and implementation of successful activities that improve clinical quality and experience for our members.
HMSA strives to deliver exceptional quality, value and customer service to our members.
Maximizing health plan quality performance ratings and payments is critical to maintaining our competitiveness in the market and supports excellence for our members in the areas of clinical quality, experience, and health plan operations.
Minimum Qualifications Bachelor's degree and five years of related work experience; or equivalent combination of education and related work experience.
Two years of previous supervisory/management; or four (4) years of previous leadership experience.
Strong working knowledge of Healthcare Effectiveness Data and Information Set (HEDIS), Consumer Assessment of Healthcare Providers and Systems (CAHPS) processes, or NCQA performance standards.
Experience leading diverse teams in matrix organizations.
Experience/skill in driving change and innovative thinking in continuous quality improvement.
Basic working knowledge of Microsoft Office applications.
Including but not limited to Word, Excel, Outlook, and Power Point.
Duties and Responsibilities Quality Performance Develops short-term and long-term strategies to meet health plan quality performance goals and requirements.
Works internally, and with BCBSA, providers and vendors to review programs, processes, and data collection for improvement opportunities.
Ensures quality improvement processes and documentation support Quality Assurance and Performance Improvement program requirements.
Manages the production of performance dashboards to monitor and report ongoing performance against targets.
Adjusts as needed to ensure goals are met.
Supports internal and external teams as a subject matter expert of Healthcare Effectiveness Data and Information Set (HEDIS) and Consumer Assessment of Healthcare Providers and Systems (CAHPS) technical specifications and reporting logistics for quality performance measures.
Ensures deliverables for external submissions (e.
g.
, CMS, OPM, MQD, etc.
) are completed timely and in meet applicable requirements.
Program Leadership Manages quality improvement team members and vendors in order to achieve program and project goals.
Adjusts roles and responsibilities as needs change.
Champions a blend of proven quality improvement methodologies as the framework for supporting clinical, member experience and/or operational improvement projects.
Provides direction in areas including project scope definition, risk identification, resource allocation, implementation, and other areas using project management techniques.
Manages priorities, resource constraints, project issues and other factors to ensure that timelines, deliverables and budgets are understood and achieved by staff.
Prepares documentation and monitors projected versus actual expenditures for budgets within areas of responsibility.
Cross-Functional Integration and Communication Acts as the leader and champion of quality improvement interventions.
Collaborates with cross-departmental business leaders and external partners to achieve common goals.
Develops strong business partnerships with key areas throughout the organization and external partners to continually improve quality performance.
Provides education and information to the entire HMSA community regarding health plan quality performance.
Communicates performance results to all levels of staff including executive management as needed.
Continuously reviews and implements opportunities to further align quality improvement activities with standard department workflows.
Management and Leadership Manages quality improvement interventions staff in assignment of projects and work, performance management, career development, compensation, recruitment, training and development.
Performs all other miscellaneous responsibilities and duties as assigned or directed.
Recommended Skills Career Development Clinical Works Content Management Continuous Quality Improvement (Cqi) Customer Service Dashboard Estimated Salary: $20 to $28 per hour based on qualifications.
HMSA strives to deliver exceptional quality, value and customer service to our members.
Maximizing health plan quality performance ratings and payments is critical to maintaining our competitiveness in the market and supports excellence for our members in the areas of clinical quality, experience, and health plan operations.
Minimum Qualifications Bachelor's degree and five years of related work experience; or equivalent combination of education and related work experience.
Two years of previous supervisory/management; or four (4) years of previous leadership experience.
Strong working knowledge of Healthcare Effectiveness Data and Information Set (HEDIS), Consumer Assessment of Healthcare Providers and Systems (CAHPS) processes, or NCQA performance standards.
Experience leading diverse teams in matrix organizations.
Experience/skill in driving change and innovative thinking in continuous quality improvement.
Basic working knowledge of Microsoft Office applications.
Including but not limited to Word, Excel, Outlook, and Power Point.
Duties and Responsibilities Quality Performance Develops short-term and long-term strategies to meet health plan quality performance goals and requirements.
Works internally, and with BCBSA, providers and vendors to review programs, processes, and data collection for improvement opportunities.
Ensures quality improvement processes and documentation support Quality Assurance and Performance Improvement program requirements.
Manages the production of performance dashboards to monitor and report ongoing performance against targets.
Adjusts as needed to ensure goals are met.
Supports internal and external teams as a subject matter expert of Healthcare Effectiveness Data and Information Set (HEDIS) and Consumer Assessment of Healthcare Providers and Systems (CAHPS) technical specifications and reporting logistics for quality performance measures.
Ensures deliverables for external submissions (e.
g.
, CMS, OPM, MQD, etc.
) are completed timely and in meet applicable requirements.
Program Leadership Manages quality improvement team members and vendors in order to achieve program and project goals.
Adjusts roles and responsibilities as needs change.
Champions a blend of proven quality improvement methodologies as the framework for supporting clinical, member experience and/or operational improvement projects.
Provides direction in areas including project scope definition, risk identification, resource allocation, implementation, and other areas using project management techniques.
Manages priorities, resource constraints, project issues and other factors to ensure that timelines, deliverables and budgets are understood and achieved by staff.
Prepares documentation and monitors projected versus actual expenditures for budgets within areas of responsibility.
Cross-Functional Integration and Communication Acts as the leader and champion of quality improvement interventions.
Collaborates with cross-departmental business leaders and external partners to achieve common goals.
Develops strong business partnerships with key areas throughout the organization and external partners to continually improve quality performance.
Provides education and information to the entire HMSA community regarding health plan quality performance.
Communicates performance results to all levels of staff including executive management as needed.
Continuously reviews and implements opportunities to further align quality improvement activities with standard department workflows.
Management and Leadership Manages quality improvement interventions staff in assignment of projects and work, performance management, career development, compensation, recruitment, training and development.
Performs all other miscellaneous responsibilities and duties as assigned or directed.
Recommended Skills Career Development Clinical Works Content Management Continuous Quality Improvement (Cqi) Customer Service Dashboard Estimated Salary: $20 to $28 per hour based on qualifications.
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