Quality Manager

Summary:

The primary function of the Quality Program Manager is responsible for providing day to day management of the quality improvement program. Responsible for coordinating activities of quality department staff, suggesting process changes, measuring data, and completing QA activities to achieve organization goals for quality measures for programs like UDS, Accountable Care/Clinically Integrated Networks, Ohio Medicaid CPC, CPC Kids, CMC, and individual insurance plan contracts.

Reports to: Director of Quality and Clinical Systems

Supervises: Yes

Dress Requirement: Business Casual

Work Schedule:

Monday through Friday during standard business hours

Times are subject to change due to business necessity

Exempt

Essential Job Duties and Responsibilities

• Work with supervisor and members of clinical leadership to develop, implement, monitor, and measure plans to improve processes and quality outcomes.
• Work with supervisor, clinical leadership, data analytics team, and external data vendor Unity PHM to analyze data, clean data, and perform quality assurance activities.
• In collaboration with supervisor, Chief Medical Officer, and others, the position is responsible for carrying out system-wide quality programs. Assists with developing, planning, and implementing policies and procedures.
• Works closely with supervisors, clinical teams, and non-clinical teams for quality improvement efforts. Assists with designing processes for quality improvement purposes.
• Plays a key role in maximizing revenue from value-based care, pay-for-performance, and risk adjustment contracts. Ensure compliances with program requirements. Examples include individual insurance plan contracts, Accountable Care/Clinically Integrated Networks, Ohio Medicaid CPC, CPC Kids, and CMC programs.
• Focuses on better healthcare value and quality, including the improvement of clinical outcomes, patient experience, patient safety, costs, revenue, productivity, efficiency, employee and physician satisfaction, and process reliability.
• Leads or participates in meetings related to quality improvement.
• Coordinate, manage and report UDS measures and other data related to clinical quality.
• Manages performance improvement projects to assure milestones and key performance indicators are met within defined parameters. Documents the results of projects, and submits other documentation as requested.
• Develop and motivate department staff. Interview, monitor time and attendance, and manage performance of subordinates.
• Report on clinical quality measures internally and externally. Provide updates to internal and external stakeholders on progress in quality initiatives.
• Support data collection and reporting related to grants.
• This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee. Duties, responsibilities and activities may change or new ones may be assigned at any time with or without notice.

Equipment Operated:

Facility Environment:

Heart of Ohio Family Health operates in multiple locations, in Columbus, OH. All facilities have a medical office environment with front-desk reception area, separate patient examination rooms, nursing stations, pharmacy stock room, business offices, hallways and private toilet facilities. All facilities are ADA compliant.

The patient examination rooms and office area is:

• kept at a normal working temperature
• sanitized daily
• maintains standard office environment furniture with adjustable chairs
• maintains standard office equipment; i.e., computer, copier, fax machine, etc. at a normal working height

Physical Demands and Requirements: these may be modified to accurately perform the essential functions of the position:

• Mobility = ability to easily move without assistance
• Bending = occasional bending from the waist and knees
• Reaching = occasional reaching no higher than normal arm stretch
• Lifting/Carry = ability to lift and carry a normal stack of documents and/or files
• Pushing/Pulling = ability to push or pull a normal office environment
• Dexterity = ability to handle and/or grasp, use a keyboard, calculator, and other office equipment accurately and quickly
• Hearing = ability to accurately hear and react to the normal tone of a person’s voice
• Visual = ability to safely and accurately see and react to factors and objects in a normal setting
• Speaking = ability to pronounce words clearly to be understood by another individual

Qualifications

Education:

• Bachelor’s degree in a related field required. Examples include nursing, healthcare administration, public health, or similar.
• Certifications such as CPHQ and Lean Six Sigma are beneficial, but not required.

Experience:

• At least four years of experience in the healthcare field, quality, data analytics, and/or management strongly preferred. Master’s level education and appropriate background may substitute for some experience.
• Knowledge of clinical operations including the functions of the front and back-office utilization information systems is preferred.
• Previous experience working in an outpatient clinic is preferred.

Knowledge/Abilities:

• Excellent communication skills, both written and verbal, are required.
• Strong organization and time management skills are required.
• Ability to work independently and demonstrate initiative is required.
• Proficiency with Microsoft Office is required.
• Displays cheerful demeanor and makes positive comments when on duty.
• Works cooperatively with other staff members.
• Displays sensitivity in a multi-cultural environment.
• General understanding of the medical billing process is preferred.