Quality Manager (Ormond Beach, FL Area)

Quality Manager

The Quality Manager leads a team of Quality Specialists to coordinate and execute Quality activities across the organization to advance value-based payment and population health priorities. The Quality Manager provides leadership in deploying tactics and resources to successfully meet the defined quality priorities and track progress toward those goals. This position will analyze data to identify and address care gaps, provide performance feedback and tools to clinics/programs. The Quality Manager position will collaborate with key internal stakeholders, including Sr. Director of MRA and Quality and clinical operations, as well as insurance payors to support Quality initiatives designed to improve the quality of care and health of the communities Complete Health serves.

Primary Responsibilities:

• Manage a team of Quality Specialists that supports quality priorities.
• Oversee and monitor insurance payor data, including performance tracking across contracts, producing actionable gap lists for key stakeholders, and conducting regular chart/data audits.
• Coordinate and perform Quality activities for quality improvement initiatives set forth by Sr. Director, MRA and Quality and Sr. Vp, Value Based Care.
• Conduct ongoing analysis of data to assess gaps in and barriers to patient care and identify action plans and opportunities to implement evidence-based protocols ensuring alignment of HEDIS.
• Develop care team training materials and lead or coordinate trainings as appropriate to meet Quality needs of the organization.
• Actively participate and be an organizational leader with insurance payors, including attending regular meetings and tracking all updates and needs.
• Participates in additional meetings with external and internal stakeholders, as needed.
• Perform other duties related to quality improvement as assigned by Sr. Director, MRA and Quality.

Key Skills, Knowledge & Abilities

Required For This Job:

• Strong analytical and systemic thinking skills, with ability to synthesize information from multiple data sources to develop recommendations
• Familiarity with HEDIS data sets and population health principles
• Expertise with continuous quality improvement, process mapping, root cause analysis, and developing standard workflows
• Strong comprehension of value-based care and population health concepts, and experience in Medicare Managed Care
• Ability to provide training and education to staff at all levels
• Well-developed written and oral communication skills, including facilitating conversations and presenting
• Knowledge of ambulatory electronic health records, preferably with Athena and eCW
• Utilization of Microsoft Office Suite (Word, Excel, Outlook, PowerPoint, SharePoint)
• Proficient in using advanced Excel features such as pivot tables, complex formulas, and data visualization tools (charts/graphs)
• Strong organizational skills to prioritize multiple tasks and projects under tight deadlines
• Ability to effectively utilize or quickly learn various population health and clinical data report platforms, as well as comfort managing large datasets
• High degree of adaptability, productivity, reliability, and ability to work independently.

Required Qualifications

• A minimum of two (2) years of experience in the health care industry, in HEDIS and/or quality improvement. Experience in a managed care health services environment. Demonstrated knowledge of data collection, medical record review, and data extraction. NCQA and HEDIS experience.
• Experience in Primary Care clinical background setting