Manager Quality Management - Ohio RN

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.

Responsibilities:

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. ; State contract requirements including quality withhold, minimum performance standards, quality based assignments, etc. and requirements of regulatory bodies. ;
• Oversight of the Quality of Care reviews including training of clinical team and auditing.
• 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. ;Improve HEDIS and CAHPS. ;
• 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.
• Registered Nurse;required.;
• 3 to 5 years management experience in Quality Improvement.
• 10 or more years progressively responsible experience in a health-related position.
• Previous experience in managed care is required. ;
• IHI model for improvement experience is a plus.
• CPHQ certification is a plus.
  
  

Diversity, Equity, and Inclusion

At Amerihealth Caritas, everyone can feel valued, supported, and comfortable to be themselves. Our commitment to equity means that all associates have a fair opportunity to achieve their full potential. We put these principles into action every day by acting with integrity and respect. We stand together to speak out against injustice and to break down barriers to support a more inclusive and equitable workplace. Celebrating and embracing the diverse thoughts and perspectives that make up our workforce means our company is more vibrant, innovative, and better able to support the people and communities we serve.

We keep our associates happy so they can focus on keeping our members healthy.

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.

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