Manager Quality Management

AmeriHealth Caritas

Raleigh, NC(remote)

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JOB DETAILS

SKILLS

Accreditation Standards, Administrative Policies, Administrative Procedures, Administrative Skills, Behavioral Health, Biotech and Pharmaceutical, Broadband, Compensation and Benefits, Diversity, Health Plan, Healthcare, Healthcare Effectiveness Data and Information Set (HEDIS), Healthcare Quality, Maintain Compliance, Managed Care, National Committee for Quality Assurance (NCQA), Operational Strategy, Operations Planning, Operations Processes, Organizational Skills, Performance Management, Pharmacy, Pilot Manager, Policy Development, Problem Solving Skills, Procedure Development, Process Improvement, Product Management, Quality Management, Quality Monitoring, Regulatory Compliance, Regulatory Reports, Regulatory Requirements, State Laws and Regulations, Strategic Planning, Time Management

LOCATION

Raleigh, NC

POSTED

Today

Under the direction of the Director, Quality Management, the Manager of Quality Management is responsible for providing oversight, direct supervision and day-to-day management of the Quality Management Team. This position oversees integration of quality monitoring and interventions for improving HEDIS rates and provides process assistance to business owners for performance improvement projects. The incumbent provides direction and support to the Quality Management team and assists the Director in ensuring Plan compliance with state regulations and accreditation standards.

+ Directs the Quality Operations Program, following the National Committee for Quality Assurance (NCQA) Standards and Guidelines Quality Management, as well as, the contract with the State and requirements of regulatory bodies

+ Maintains current knowledge of Health Plan Policy and Procedures, State Requirements, NCQA Standards and HEDIS specifications.

+ Participates in the planning, developing, and implementing Health Plan activities related to the HEDIS process, improving HEDIS rates and member satisfaction.

+ Ensures the Quality Management Team complies with all applicable statutory provisions, contracts, and established policies and administrative procedures.

+ Participates and assists in the development of all necessary protocols, policies and procedures, operational strategies and plans to develop and implement Quality Management programs.

+ Ensures complete, accurate and timely reporting to regulatory bodies.

+ Supports the development and implementation of quality management programs and pilot programs designed to improve HEDIS rates and/or member satisfaction.

+ Identifies barriers to project and program success and works toward resolution by informing the accountable functional area and presenting plans to resolve the issue when possible.

Education/ Experience:

+ Bachelor’s Degree in a Health Related field required.

+ RN required

+ 3 to 5 years management experience in Quality Improvement.

+ 10 or more years progressively responsible experience in a health related position.

Other Skills:

+ Performance/Quality Improvement Coordinator (Manager) shall be a certified professional in healthcare quality (CPHQ) or certified in health care quality and management (CHCQM) or comparable education and experience in data and outcomes measurement required.

+ Previous experience in managed care required.

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.

For roles that are 100% remote or hybrid, you must have access to a reliable high-speed internet connection to support daily job responsibilities. A minimum bandwidth of 50 Mbps download and 5 Mbps upload is required. Those fully remote associates residing in states where service is required by contract, law, or regulation will be allowed to submit for reimbursement.

Your career starts now. We’re looking for the next generation of health care leaders.

At AmeriHealth Caritas, we’re 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’d like to hear from 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 www.amerihealthcaritas.com .
As a company, we support internal diversity through:

Recruiting. We are an equal opportunity employer. We do not discriminate on the basis of age, race, ethnicity, gender, religion, sexual orientation, or disability. Our inclusive, equitable approach to recruiting and hiring reinforces our commitment to DEI.

About the Company

AmeriHealth Caritas

Leaders in health care solutions for those most in need

AmeriHealth Caritas is the nation's leader in providing comprehensive health care solutions for those in most need and the chronically ill. We impact the lives of more than 5.7 million members nationwide. With more than 30 years of experience managing care for individuals and families in publicly-funded programs, we have become known for developing innovative solutions that help improve health outcomes while reducing costs.

Our mission, our goal

Our mission is to help people get care, stay well and build healthy communities. Our goal is to provide responsible managed care solutions, including Medicaid, Medicare, and CHIP - plus behavioral health, pharmacy benefits management and third-party management and administrative services.

COMPANY SIZE

5,000 to 9,999 employees

INDUSTRY

Healthcare Services

FOUNDED

1985

WEBSITE

http://www.amerihealthcaritas.com

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