Quality Improvement Program Manager - Rancho Cucamonga, United States - Inland Empire Health Plan

Inland Empire Health Plan
Inland Empire Health Plan
Verified Company
Rancho Cucamonga, United States

3 weeks ago

Mark Lane

Posted by:

Mark Lane

beBee recruiter
Description

Salary:

$104, $137,841.60


Required Qualifications:


  • Minimum of six (6) years demonstrated experience in a clinical/health care environment with demonstrated experience in at a professional level in quality improvement/clinical program oversight/project management.
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Education: Bachelor's degree in science or health/healthcare related field from an accredited institution required.
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Professional Certification: Certified Professional of Healthcare Quality (CPHQ), or other recognized quality improvement certificate required or within one (1) year of hire (maintained through employment).
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Professional Licenses: Minimum possession of one of the following active, unrestricted, and unencumbered clinical licenses:

  • Registered Nurse (RN) license issued by the California BRN.
  • Advanced clinical licensure issued by appropriate State Board (i.e. PA).

Job Summary:

Under the direction of department leadership, the Quality Improvement Program Manager will drive quality improvement initiatives across the continuum of care (i.e. acute care hospitals, skilled nursing facilities, hospice agencies, etc.) to enhance the overall quality of care delivered to Members.

Responsible for identifying, developing, coordinating, promoting, supporting, and implementing assigned clinical quality, and/or service improvement projects and programs, the Quality Improvement Program Manager acts as a lead for evidence-based practice integration, provider training/education, policy review/development, and regulatory/accreditation interpretation.

Specifically, develops continuous and targeted activities to improve performance related to Centers for Medicare & Medicaid Services (CMS) Star Ratings, HEDIS, CAHPS, HOS, P4P and other identified performance measures.

Manages multiple complex initiatives that impact the quality or effectiveness of health care delivery and/or health care services.

Acts in conjunction with both external facing and plan quality improvement leaders and key stakeholders to provide support for multi-disciplinary teams.


Responsibilities:


  • Lead multi-department/cross-functional committees; including IEHP and external stakeholder workgroups which support key quality improvement initiatives. Accountable to broad-scale improvement efforts including Hospital value-based incentives (P4P, VBI, VBP, etc.), network-wide CMS star ratings and individual domain-level performance.
  • Develop collaborative relationships with contracted hospitals, skilled nursing facilities, hospice agencies, providers, and other external partners to promote participation in quality improvement collaboratives (i.e. forums to enhance shared learning opportunities and/or share best practices) to improve clinical care outcomes.
  • Utilize knowledge of advanced clinical processes and/or hospital operations to collaboratively develop and implement targeted activities (i.e., those based on current outcome performance and/or aligned with industry best-practices) to drive improvements in CMS Star Ratings, HEDIS, CAHPS, HOS, P4P and other identified performance measures
  • Research evidence-based practices, national and regional benchmarks, and industry standards and integrates findings into improvement initiatives.
  • Perform continuous monitoring of improvement activities via concurrent analysis of measure outcomes
  • Analyze performance outcomes and provide meaningful feedback (i.e., specific, measurable, relevant, timely, etc.) to external partners in relation to process improvement enhancements.
  • Effectively utilize performance improvement methodologies (i.e., Plan Do Study Act (PDSA)) lead the development, refinement, and implementation of rapid-cycle performance improvement.
  • Participate and describe outreach initiatives, potential/experienced barriers, and activities to resolve issues and improve outcomes.
  • Participate in the development and maintenance of annual quality improvement program documents and evaluations, compliance audits, policies and procedures, and improvement activities.
  • Support the development, upgrade, and delivery of comprehensive quality improvement training programs and problem-solving methodologies/tools to QI teams and other stakeholders as needed in collaboration with the quality improvement team.
  • Lead intradepartmental quality improvement teams, programs, projects, and initiatives as assigned.
  • Continuously seek to enhance delivery and efficiency of external-facing quality improvement initiatives via technological advancement and internal-facing process improvement.
  • Translate data into meaningful information, draw conclusions, and relate findings to industry standards. Provide recommendations to departmental stakeholders and Quality Improvement Leadership Team regarding performance gaps, program implementation, and performance outcomes in order to maintain an effective Quality Improvement program.
  • Any other duties as required ensuring Health Plan oper
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