Note: The job is a remote job and is open to candidates in USA. Home State Health is a healthcare organization seeking a Quality Program Development Manager. The role develops and implements quality programs, standards, workflows, policies, and decision-support systems while leading performance improvement projects and partnering with clinical, operational, and analytics teams to improve patient care and quality outcomes.
Responsibilities
- Oversees the creation and implementation of programs relevant to the organization's strategic initiatives involving Health Services, clinical and operational quality administration
- Designs and facilitates the development of various programs/systems, work flows, and integration efforts in alignment with Corporate, market, contractual, regulatory and quality requirements
- Acts as the content and technical subject matter expert to the operation managers and directors for key project initiatives including the development of detailed work plans, facilitating route cause analysis, identifying and socializing process enhancements, setting deadlines, assigning responsibilities, and monitoring/summarizing project progress
- Leads state required Performance Improvement Projects (PIP) including topic selection, root cause analysis, implementation, and final submission
- Conducts needs assessments and identification to ensure the program teams and other external stakeholders receive information in a timely manner
- Partners with leaders and members of the Quality Analytics and Improvement Teams and determines data needs as well as assists in designing tools and reports as necessary
- Partners with clinical and operations staff with consulting and analysis services to support initiatives intended to achieve breakthrough or incremental process improvement in patient quality of care
- Conducts other responsibilities as needed
- Performs other duties as assigned
- Complies with all policies and standards
Skills
- Required A Bachelor's Degree in a related field
- Required or equivalent work experience Business, HC Management, or Nursing:
- Required 5+ years of experience in direct program development, program management, and/or project management, preferably in a healthcare environment
- Required 3+ years of experience in managed care, plus utilization management, care coordination, disease management, Medicare, Medicaid, DSNP, dual eligibles, PCMH
- Required 2+ years of experience in design, develop and implement STARS, CAHPS, HEDIS and other enterprise quality related programs across a variety of settings including: defining the eligible population, service mix, delivery system configuration and financing; integration of behavioral, clinical, social, and community health care for members with multiple chronic conditions; working with multiple market leaders to coordinate consistent quality initiatives; conducting assessments, contractual reviews, and business plans for new quality improvement, including internally sourced or vendor sourced quality programs, and/or the integration of innovative approaches to defined programs to improve quality ratings company wide
- Preferred A Master's Degree in a related field Business or HC Management (MBA, MHA, MPH, MSN):
- A license in one of the following is preferred
- Six Sigma Certification
- Lean Certification
- Certified Professional in Healthcare Quality (CPHQ)
Benefits
- Health insurance
- 401K and stock purchase plans
- Tuition reimbursement
- Paid time off plus holidays
- A flexible approach to work with remote, hybrid, field or office work schedules
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