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Posted: 20-Nov-24
Location: Irving, Texas
Salary: Open
Categories:
Internal Number: 233276
Summary:
The Program Manager Health Plans Quality Improvement will take charge and help manage our Programs within the quality department, and to work directly with the Director of Quality, and other team members to ensure compliance with accreditation requirements are in place and re-engineered within appropriate timeframes. This role will conduct routine readiness assessment and evaluation of policies and procedures, as well as programs for CAHPs, and other initiatives.
Responsibilities:
- Active collaborator with multiple internal departments to create and implement various programs /plans under the Quality program/banner.
- Monitors the various programs (e.g. PHM Strategy) from inception through completion.
- Responsible for keeping the company current on NCQA and/or Center for
- Medicare/Medicaid Services (CMS) standards and requirements.
- Manage the health plan NCQA preparations for accreditation surveys.
- Take lead on program evaluation, program description, and work plan
- Leads and manages team in planning and executing business programs.
- Works with operational leaders within the business to provide recommendations on opportunities for process improvements.
- Lead policy and procedure documentation reviews for the health plans based on NCQA standards.
- Develop readiness assessment schedules, conduct accreditation audits and ensure changes to the standards are incorporated.
- Manage quarterly Quality Improvement Committee meetings.
- Manage all CAHPs and work with Population Health team
- Work with Project manager to coordinate and manage operational functions of quality programs
- Work closely with outreach team, special program oversight;
- Other duties as assigned.
Requirements:
- Bachelor?s Degree or equivalent combination of education and experience. Preferred Masters in Healthcare management, Health Policy, and Business management/administration
- 3-5 years of Program and/or Project management experience.
- Experience with NCQA Accreditation, NCQA file review audits and assisting with creation of NCQA reports preferred, Population health management and PDSA.
- Good writing skills and mixed model studies.
Work Type:
Full Time
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