POSITION SUMMARY

Under the general direction of the QI Director/Manager, the QI Program Manager I has primary responsibility for managing, leading, coordinating or assisting with core projects and key accountabilities of the QI team to support the GCHP mission to improve the health of members through the provision of high-quality care and services. These projects may include, but are not limited to, performance improvement projects (PIPs/IPs), health initiatives, HEDIS/MCAS, interventions to improve quality outcomes or member satisfaction, DHCS QI program requirements, NCQA Accreditation, Value-Based Payment programs (VBP) and dashboards and reporting analysis. The position may work closely with internal partners from Claims, IT, Provider Network Operations, Communications, Health Services and Member Services, and with external vendors and community partners to execute on project deliverables, foster provider engagement, and to ensure the best possible outcomes for the plan. The position will assist in data analysis and reporting for the implementation of QI Projects and/or ad hoc initiatives to support QI deliverables and regulatory compliance.

ESSENTIAL FUNCTIONS

• Coordinates, facilitates, or assists the Level II or III with multiple complex initiatives that impact the quality and/or effectiveness of health care services provided to members, ensuring compliance with accreditation and regulatory requirements.
• Research best practices, industry trends, national and regional benchmarks, and industry standards to help inform enterprise-wide strategies and to drive performance improvement for the Plan.
• Assists in providing an assessment of programs, initiatives, and interventions to determine the effectiveness of activities, improve performance and ensure that clinical and service quality improvement standards (accreditation, state and federal requirements) are met or exceeded.
• Assists in the assessment of data integrity, completeness, and data quality to determine opportunities for data enhancement and remediation of data gaps.
• Facilitates the engagement and convening of stakeholders in collaborative program development.
• Analyzes and monitors program or compliance gaps and develops improvement recommendations to ensure goals, objectives, outcomes, accreditation and regulatory requirements are met.
• Works collaboratively with other departments and leaders to design initiatives to improve study results and participates in or leads remeasurement efforts to determine effectiveness as part of the quality improvement cycle.
• Communicates programs, interventions and reports results to internal/external entities in accordance with applicable program objectives, policies and procedures, and applicable standards.
• Develops materials for and facilitates internal and external provider community training, technical assistance, and informational sessions related to assigned projects and/or health initiatives.
• Works collaboratively with internal departments to develop policies and procedures reflective of operational processes and in compliance with state and federal regulations, accreditation standards and contractual requirements.
• Completes project-related communication, including member/physician materials, project plans, reports, graphics, minutes and agendas.
• Assists or participates in relevant committees and work groups; prepares reports, data or other materials for committees and makes presentations.
• Assists in developing and/or maintaining relationships with external organizations to expand key partnerships and may represent Plan at external work groups and committees.
• Works with external vendors on project implementation and performs oversight to ensure satisfactory vendor performance and achievement of project goals.
• Other duties are requested.

POSITION QUALIFICATIONS Competency Statement(s)

• Business Acumen - Ability to grasp and understand business concepts and issues.
• Decision Making - Ability to make critical decisions while following company procedures.
• Goal Oriented - Ability to focus on a goal and obtain a pre-determined result.
• Interpersonal - Ability to get along well with a variety of personalities and individuals.
• Diversity Oriented - Ability to work effectively with people regardless of their age, gender, race, ethnicity, religion, or job type.
• Time Management - Ability to utilize the available time to organize and complete work within given deadlines.
• Consensus Building - Ability to bring about group solidarity to achieve a goal.
• Relationship Building - Ability to effectively build relationships with customers and co-workers.
• Presentation Skills - Ability to effectively present information publicly.
• Ethical - Ability to demonstrate conduct conforming to a set of values and accepted standards.
• Judgment - The ability to formulate a sound decision using the available information.
• Communication, Oral - Ability to communicate effectively with others using the spoken word.
• Communication, Written - Ability to communicate in writing clearly and concisely.
• Problem Solving - Ability to find a solution for or to deal proactively with work-related problems.

SKILLS & ABILITIES

Education: Bachelor's Degree (four-year college or technical school) Preferred

Field of Study: Business Administration, Healthcare Management, Health Informatics, Nursing, or related field

Experience: 1-2 plus years of experience in managed care

1-2 plus years of experience quality improvement/regulatory experience with increasing responsibility

Other preferred skills:

• Data analysis experience
• Project coordination experience
• Experience in developing policies and procedures.

Computer Skills: Highly competent in the MS Office products including proficiency in Word, Excel, PowerPoint and Project.

Certifications & Licenses:

• A valid and current Driver's License and Insurance.