Quality Program Manager - Honolulu, United States - AlohaCare

Description

Job Description

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The Company:

AlohaCare is a local, non-profit health plan serving the Medicaid and Medicare dual eligible population. We provide comprehensive managed care to qualifying health plan members through well-established partnerships with quality health care providers and community-governed health centers. Our mission is to serve individuals and communities in the true spirit of aloha by ensuring and advocating access to quality health care for all. This is accomplished with emphasis on prevention and primary care through community health centers that founded us and continue to guide us as well as with others that share our commitment. As Hawaii's third-largest health plan, AlohaCare offers comprehensive prevention, primary and specialty care coverage in order to successfully build a healthy Hawaii.

The Culture:

AlohaCare employees share a passion for helping Hawaii's most underserved communities. This passion for helping and caring for others is internalized and applied to our employees through a supportive and positive work environment, healthy work/life balance, continuous communication, and a generous benefits package.

AlohaCare's leadership empowers and engages its employees through frequent diversity, recognition, community, and educational events and programs. AlohaCare has a strong commitment to support Hawaii's families and reinforces a healthy work/home balance for its employees. Because AlohaCare values honesty, respect, and trust with both our internal and external customers, we encourage open-door, two-way communication through daily interactions, employee events and quarterly all-staff meetings. AlohaCare's comprehensive benefits package includes low-cost medical, dental, drug and vision insurance, PTO program, 401k employer contribution, referral bonus and pretax transportation and parking program.

These employee-focused efforts contribute to a friendly, team-oriented culture which is positively reflected into the communities we serve.

The Opportunity:

The Quality Program Manager is responsible for the development and management of clinical quality programs driving continuous quality improvement to enhance healthcare quality, improve member satisfaction and achieve organizational goals. Under the strategic direction of the Director of Quality, the Quality Program Manager will guide multidisciplinary teams through various clinical Quality initiatives and projects and provide management of key clinical quality programs and staff.

The Quality Program Manager is a champion of performance improvement and supports Quality-owned NCQA accreditation initiatives. This includes leading workgroups and authoring reports for submission and presentation to Quality committees.

Primary Duties and Responsibilities:

• Acts as the organization's licensed clinical representative to the State's MedQUEST Division
• Management and oversight of the following quality programs: Quality of care, adverse events, and Early, Periodic, Screening, Diagnostic, and Treatment (EPSDT) program. Oversees design, implementation, and reporting of all federally mandated Quality/Performance Improvement Projects: (PIPs, CCIP).
• Lead the development and implementation of quality initiatives to enhance healthcare quality and improve outcomes for members.
• Supports measure-level goals with Quality leadership team to drive the organization's overall performance improvement.
• Collaborate with cross-functional teams to identify areas for improvement and develop action plans to address gaps in quality measures such as HEDIS, Stars, CAHPS, and HOS.
• Leads clinical quality workgroups for continuous targeted quality improvement.
• Maintains applicable Quality policies and procedures.
• May lead and manage key Quality regulatory and accreditation reports.
• Trains and develops staff in collaboration with the Director of Quality.
• Provides direction to professional and paraprofessional staff.
• Hires, coaches, counsels, and evaluates performance of direct reports.
• Ensures compliance with all required activities, established timeframes, and mandatory reporting.
• Develops and maintains strong relationships within the community including State leaders, providers, vendors, business partners and community alliances.
• Facilitates and participates in departmental meetings, and manager meetings as required.
• Develops and maintains organizational Clinical Guidelines to be presented and approved by Provider Advisory Council and other committees as appropriate.
• Responsible to maintain AlohaCare's confidential information in accordance with AlohaCare policies, and state and federal laws, rules, and regulations regarding confidentiality. Employees have access to AlohaCare data based on the data classification assigned to this job title.
• Other duties as assigned.

Requirements:

• Bachelor's degree in nursing, Public Health, Health Care Administration, or other related field
• Minimum of 3-5 years Quality experience in a health plan or healthcare-related setting
• Minimum of 3-5 years of management experience and/or oversight of related areas
• Physician, Nurse Practitioner or Registered Nurse licensed in the state of Hawaii
• Ability to multi-task, adapt to changing priorities, manage a diversity of high priority projects in a fast-paced environment.
• Knowledge of Project Management principles
• Knowledge of Quality Improvement principles
• Strong verbal and written communication in English.
• Technical writing expertise
• Ability to work independently with minimal supervision
• Proficient knowledge of spreadsheets/graphics, presentation, and databases
• Strong analytical skills, communication skills, and relationship skills
• Ability to work on multiple projects concurrently and prioritize tasks appropriately
• Ability to define problems, collect data, establish facts, and draw valid conclusions. Ability to interpret an extensive variety of technical instructions and deal with several abstract and concrete variables.
• Ability to make critical decisions
• Self-starter with ability to think, work, and problem solve with limited direction.
• Ability to make effective and persuasive presentations on controversial or complex topics
• Requires operation of general office equipment to include; PC, fax/copy machine and ACD Phones.
• Working knowledge of Microsoft Access, Excel, Word, Outlook and PowerPoint
• Ability and experience supervising multiple staff

Preferred Requirements

• Master's degree in healthcare related field
• Certified Professional in HealthCare Quality (CPHQ)

Mental, Physical and Environmental Demands:

• Sedentary Work: Exerting up to 20 pounds of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects. Sedentary work involves sitting most of the time but may involve walking or standing for brief periods of time.
• Inside working conditions
• No environmental hazards
• Requires operation of general office equipment to include PC

Salary Range: $85,000 - $100,000 annually

AlohaCare is committed to providing equal employment opportunity to all applicants in accordance with sound practices and federal and state laws. Our policy prohibits discrimination and harassment because of race, color, religion, sex (including gender identity or expression), pregnancy, age, national origin, ancestry, marital status, arrest and court record, disability, genetic information, sexual orientation, domestic or sexual violence victim status, credit history, citizenship status, military/veterans' status, or other characteristics protected under applicable state and federal laws, regulations, and/or executive orders.