Medicaid Quality Management Health Plan Director

Medicaid Quality Management Health Plan Director

Requirements

• Requires BA/BS in a clinical or health care field (i.e. nursing, epidemiology, health sciences) and a minimum 5 years progressively responsible experience in a health care environment or any combination of education and experience, which would provide an equivalent background.

Responsibilities

• Works with both internal and external customers to promote understanding of quality management activities and objectives within the company and to prioritize departmental projects according to corporate, regional, and departmental goals.
• Maintains expert knowledge of current industry standards, quality improvement activities, and strong medical management skills.
• Serves as a resource for the design and evaluation of process improvement plans/quality improvement plans and ensures they meet Continuous Quality Improvement (CQI) methodology and state contractual requirements.
• Collaborates with other leaders in developing, monitoring, and evaluating Healthcare Effectiveness Data Information Set (HEDIS) improvement action plans, year round medical record review, and over read processes.
• Monitors and reports quality measures per state, Centers for Medicare and Medicaid Services (CMS), and accrediting requirements.

Preferred Qualifications

• MS or advanced degree in a health care related field (i.e. nursing, health education) or business strongly preferred.
• Previous experience working with NCQA, and HEDIS preferred.