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Director Quality Management - Charleston, United States - AmeriHealth Administrators
Description
Your career starts now. We are looking for the next generation of health care leaders.At AmeriHealth Caritas, we are passionate about helping people get care, stay well and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we would like to connect with you.
Headquartered in Newtown Square, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services.
Discover more about us at
Responsibilities:
The Director of Quality Management is responsible for the Outcomes Management and Quality Improvement Plan, a program of systematic and objective activities designed to continuously monitor, evaluate, and improve the processes of delivering behavioral health and substance use services, services for intellectual/developmental disabilities, and the quality of clinical care and services provided to children, youth, young adults and their family/caregivers. The Director is responsible for a formal outcomes assessment process that is standardized, reliable, and valid in accordance with industry standards.
The Quality Improvement program includes the overall management of complaints and grievances; evaluation of the quality of clinical care provided to youth and families; and the organization-wide monitoring, analysis, and improvement of clinical and non-clinical processes. This position works in collaboration with the State to support the Systems Review Process. This position is responsible for working with various departments across the organization to provide an integrated approach to quality of care. The Director of Quality Management provides quality leadership in the development of new and improved clinical and administrative processes to maximize effective operations and ensures that contract deliverables are met. This position takes a leadership role for certification, accreditation and other internal and external audit processes; critical incident management; outlier and outcomes management, compliance with applicable fraud and abuse state and federal regulations; and coordinating these requirements with the local Compliance Manager. This position ensures policies and procedures are reviewed and revised annually or as required by the line of business. The Director of Quality Management supervises a team of quality coordinators, manages assignments and provides feedback on job performances and goals.
Education/Experience:
At AmeriHealth Caritas, everyone can feel valued, supported, and comfortable to be themselves. Our commitment to equity means that all associates have a fair opportunity to achieve their full potential. We put these principles into action every day by acting with integrity and respect. We stand together to speak out against injustice and to break down barriers to support a more inclusive and equitable workplace. Celebrating and embracing the diverse thoughts and perspectives that make up our workforce means our company is more vibrant, innovative, and better able to support the people and communities we serve.
We keep our associates happy so they can focus on keeping our members healthy.
Our Comprehensive Benefits Package
Flexible work solutions including remote options, hybrid work schedules, Competitive pay, Paid time off including holidays and volunteer events, Health insurance coverage for you and your dependents on Day 1, 401(k) Tuition reimbursement and more.
