VP Quality Management - Plan
Job ID 2013-22771 # Positions 1
Location US-CA-Thousand Oaks
Search Category Health Care Operations
Type Regular Full-Time (30+ hours) Posted Date 5/6/2013
Additional Locations ..
More information about this job:
Summary:
The Vice President of Clinical Quality Management is responsible, in conjunction with the Chief Medical Officer or his designee, for developing, coordinating, and implementing clinical quality initiatives within all health plans and departments of AMERIGROUP Corporation. This includes establishing indicators for monitoring and evaluating the quality and appropriateness of care/service, assessing for continuous improvement in monitored indicator activities, monitoring member satisfaction, and directing initiatives for improvement and evaluating the effectiveness of interventions across the continuum of care to members. Maintains liaison for clinical quality initiatives with state/federal regulatory agencies and collaborates with Government Relations leaders to meet external quality information needs. The VP Clinical Quality Management provides operational leadership for companywide HEDIS reporting, member/provider satisfaction surveying, appeals processing, QM scorecard reporting, HIPAA privacy compliance, and QM new business development. The VP Clinical Quality Management works to establish and promote a culture of operational excellence.
Responsibilities:
1. Provides leadership for implementation of the comprehensive Clinical Quality Management Program for AMERIGROUP Corporation or the individual plan to meet the demographic and epidemiological needs of the population served.
2. Establishes objectives and annual goals in conjunction with the Chief Medical Officer or his designee. 2. Promotes organization--wide understanding, communication, and coordination of the Clinical Quality Management Program.
3. Oversees the companywide QM Scorecard reporting including analyzing validity of Clinical Quality management data/reports from a clinical perspective.
4. Provides leadership for the development, implementation, and evaluation of Clinical Quality improvement action plans for clinical quality improvement activities.
5. Oversees the member complaint process across the company.
6. Oversees the privacy compliance process across the company.
7. Oversees the centralized appeal process across the company.
8. Provides leadership for and supervises the member/provider satisfaction survey process.
9. Oversees Health Employer Data Information Sets (HEDIS) reporting and provides leadership to the development and realization of action plans to achieve target improvement goals.
10. Supports the health plans’ External Quality Review Organization (EQRO) state audit processes.
11. Oversees and provides leadership for the companywide Quality Improvement Council (QIC).
12. Provides supervision and leadership to QM representation in new business activities (RFP responses, new market/product development, and state contract changes etc.)
13. Provides organizational leadership to comply with National Committee for Quality Assurance (NCQA) standards, or other accrediting bodies such as URAC and AAAHC.
14. Provides leadership and makes recommendations for provider recredentialing in the areas of medical record reviews, Clinical Quality indicators, performance and quality of care actions.
15. Assures compliance with State and Federal quality improvement/assurance requirements.
16. Collaborates with Government Relations and External Communication leaders to meet the QM information needs of customers.
17. Oversees delegated services QM auditing including ensuing evaluations/recommendations for improvement.
18. Develops the annual operating and capital budgets to sufficiently meet departmental needs and ensures that department stays within budget and accounts for variances.
19. Interviews, manages, evaluates, and develops new and existing departmental staff.
20. Other duties as requested or assigned.
Qualifications:
EDUCATION AND EXPERIENCE
Education
Required:
- Bachelor Degree
Preferred:
- MSN, MPH, MPA
Years and Type of Experience Required:
Required:
- Must have twelve or more years of current progressive experience in quality management, and quality improvement, risk management, and/or utilization management in a managed care setting and seven years of leadership/management experience.
- Previous NCQA accreditation and HEDIS reporting experience required.
- CPHQ
Preferred:
- Experience with the urban Medicaid population preferred.
Specific Technical Skills
Required:
- Knowledge of basic computers including work processing and spread sheets.
Preferred:
- Experience with data base applications.
Certifications or Licensure
Preferred:
- Current RN state license (as may be required by Plan.)
Other:
- Strong knowledge base in areas of quality improvement and risk management.
- Excellent verbal and written communication skills.
- Ability to work effectively with physicians and other health care providers.
- Demonstrated ability to be a team builder and work in a team environment with self-directed work groups.
- Excellent problem solving skills.
- Strong organizational skills.
- Ability to develop and give presentations and to assume the role of facilator.
- Ability to handle multiple tasks.
- Appreciation of cultural diversity and sensitivity towards target population.
SCOPE INFORMATION
# Direct Reports: Will have direct reports.
# Indirect Reports: Will have indirect reports.
Budgetary $ Responsibility: Will be responsible for departmental budget.
PHYSICAL REQUIREMENTS
- Must be able to operate a computer.
- Must be able to operate a telephone.
- Must be able to travel on common carriers and to adhere to AMERIGROUP’s travel policies.
AGP Job Title: VP QM
AGP Grade level: 23
AGP Compensation range: $107,021k - $142,695- $178,369k
AGP MJO: 20%
AGP LTI: $15K
Job ID 2013-22771 # Positions 1
Location US-CA-Thousand Oaks
Search Category Health Care Operations
Type Regular Full-Time (30+ hours) Posted Date 5/6/2013
Additional Locations ..
More information about this job:
Summary:
The Vice President of Clinical Quality Management is responsible, in conjunction with the Chief Medical Officer or his designee, for developing, coordinating, and implementing clinical quality initiatives within all health plans and departments of AMERIGROUP Corporation. This includes establishing indicators for monitoring and evaluating the quality and appropriateness of care/service, assessing for continuous improvement in monitored indicator activities, monitoring member satisfaction, and directing initiatives for improvement and evaluating the effectiveness of interventions across the continuum of care to members. Maintains liaison for clinical quality initiatives with state/federal regulatory agencies and collaborates with Government Relations leaders to meet external quality information needs. The VP Clinical Quality Management provides operational leadership for companywide HEDIS reporting, member/provider satisfaction surveying, appeals processing, QM scorecard reporting, HIPAA privacy compliance, and QM new business development. The VP Clinical Quality Management works to establish and promote a culture of operational excellence.
Responsibilities:
1. Provides leadership for implementation of the comprehensive Clinical Quality Management Program for AMERIGROUP Corporation or the individual plan to meet the demographic and epidemiological needs of the population served.
2. Establishes objectives and annual goals in conjunction with the Chief Medical Officer or his designee. 2. Promotes organization--wide understanding, communication, and coordination of the Clinical Quality Management Program.
3. Oversees the companywide QM Scorecard reporting including analyzing validity of Clinical Quality management data/reports from a clinical perspective.
4. Provides leadership for the development, implementation, and evaluation of Clinical Quality improvement action plans for clinical quality improvement activities.
5. Oversees the member complaint process across the company.
6. Oversees the privacy compliance process across the company.
7. Oversees the centralized appeal process across the company.
8. Provides leadership for and supervises the member/provider satisfaction survey process.
9. Oversees Health Employer Data Information Sets (HEDIS) reporting and provides leadership to the development and realization of action plans to achieve target improvement goals.
10. Supports the health plans’ External Quality Review Organization (EQRO) state audit processes.
11. Oversees and provides leadership for the companywide Quality Improvement Council (QIC).
12. Provides supervision and leadership to QM representation in new business activities (RFP responses, new market/product development, and state contract changes etc.)
13. Provides organizational leadership to comply with National Committee for Quality Assurance (NCQA) standards, or other accrediting bodies such as URAC and AAAHC.
14. Provides leadership and makes recommendations for provider recredentialing in the areas of medical record reviews, Clinical Quality indicators, performance and quality of care actions.
15. Assures compliance with State and Federal quality improvement/assurance requirements.
16. Collaborates with Government Relations and External Communication leaders to meet the QM information needs of customers.
17. Oversees delegated services QM auditing including ensuing evaluations/recommendations for improvement.
18. Develops the annual operating and capital budgets to sufficiently meet departmental needs and ensures that department stays within budget and accounts for variances.
19. Interviews, manages, evaluates, and develops new and existing departmental staff.
20. Other duties as requested or assigned.
Qualifications:
EDUCATION AND EXPERIENCE
Education
Required:
- Bachelor Degree
Preferred:
- MSN, MPH, MPA
Years and Type of Experience Required:
Required:
- Must have twelve or more years of current progressive experience in quality management, and quality improvement, risk management, and/or utilization management in a managed care setting and seven years of leadership/management experience.
- Previous NCQA accreditation and HEDIS reporting experience required.
- CPHQ
Preferred:
- Experience with the urban Medicaid population preferred.
Specific Technical Skills
Required:
- Knowledge of basic computers including work processing and spread sheets.
Preferred:
- Experience with data base applications.
Certifications or Licensure
Preferred:
- Current RN state license (as may be required by Plan.)
Other:
- Strong knowledge base in areas of quality improvement and risk management.
- Excellent verbal and written communication skills.
- Ability to work effectively with physicians and other health care providers.
- Demonstrated ability to be a team builder and work in a team environment with self-directed work groups.
- Excellent problem solving skills.
- Strong organizational skills.
- Ability to develop and give presentations and to assume the role of facilator.
- Ability to handle multiple tasks.
- Appreciation of cultural diversity and sensitivity towards target population.
SCOPE INFORMATION
# Direct Reports: Will have direct reports.
# Indirect Reports: Will have indirect reports.
Budgetary $ Responsibility: Will be responsible for departmental budget.
PHYSICAL REQUIREMENTS
- Must be able to operate a computer.
- Must be able to operate a telephone.
- Must be able to travel on common carriers and to adhere to AMERIGROUP’s travel policies.
AGP Job Title: VP QM
AGP Grade level: 23
AGP Compensation range: $107,021k - $142,695- $178,369k
AGP MJO: 20%
AGP LTI: $15K