Virginia Premier Health Plan, Inc.

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Sr. Manager, Quality - Medicare Advantage

Sr. Manager, Quality - Medicare Advantage

Job Locations 
US-VA-Glen Allen
Job ID 
2017-4212

Job Description

Overview

The Sr. Quality Manager will support the Director of Quality STARs in all quality (e.g., accreditation and regulatory) related activities, in multi-states when applicable, to include, but not limited to efforts associated with or required by the National Committee for Quality Assurance (i.e. NCQA), which includes the Healthcare Effectiveness Data and Information Set (i.e. HEDIS), a registered trademark of NCQA, the Department of Medical Assistance Services (i.e. DMAS), the Centers for Medicare and Medicaid Services (i.e. CMS) and other required entities associated with or required by the State and/or Federal Government. The Sr. Quality Manager will assist leadership in establishing the Quality Performance Initiatives on impacting HEDIS or STARs measures and Consumer and Health Plan Surveys (CAHPS) or other member satisfaction ratings. The incumbent will assist in the oversight and management of implementing quality strategies for closing care gaps. This role works closely and collaboratively with various functional areas of the organization to achieve the goals and objectives of the Quality Program. Travel is mandatory.

Responsibilities

  • Supervise and manage day to day operations of all STARs staff (clinical and nonclinical)
  • Maintain and generate all production reports and metrics on a monthly basis, while assessing trends, identifying barriers and implementing improvement strategies
  • Design, develop and implement quality improvement activities, as required
  • Works collaboratively with network providers/practitioners to execute the implementation of the clinical quality initiatives such as electronic medical record (eMR) data abstraction and transmission
  • Adhere to and enforce VPHP policies and procedures
  • Implement clinical and operational initiatives through a multidisciplinary approach within the Quality department to ensure compliance with NCQA, DMAS and CMS standards
  • Lead HEDIS related projects (or other projects as deemed appropriate) and implement interventions using a multidisciplinary approach to achieve quality outcomes 
  • Other duties, as required such as conducting onsite visits and/or medical record reviews of practitioners/providers in response to random assessment requirements/needs, quality of care indicators, quality of care grievances, quality committee (i.e., Credentialing, Health Quality and Utilization Management, etc) reviews, clinical studies NCQA guidelines/requirements to include HEDIS related activities, educating the network practitioners/providers and for any other reason deemed appropriate
  • Other quality related duties, as assigned and/or as specified

Qualifications

 

MINIMUM EDUCATION REQUIREMENTS: 

  • Registered Nurse; licensed in State of Virginia
  • Bachelors degree preferred but not required.
  • Three or more years of management experience preferred
  • Two or more years of project management experience

SPECIAL KNOWLEDGE AND/OR SKILLS:

  • Regulatory reporting OR Managed Care experience
  • HEDIS/STAR experience preferred but not required
  • Healthcare Quality Improvement experience
  • Six Sigma Green Belt Completion or CPHQ Certification (Highly Preferred; not required)
  • Proven HEDIS Medical Record Abstraction Experience (Highly Preferred; not required)
  • Proven Member and Practitioner/Provider HEDIS Education (Highly Preferred; not required)

WORK BACKGROUND EXPERIENCE:

  • Quality project management, design and implementation experience
  • Experience interacting with physicians and other healthcare providers
  • Excellent training and presentation skills with solid communication capabilities and practices, both oral and written
  • Experience extracting and analyzing quality data preferred
  • Managed care experience to include conducting health plan audits
  • Multi-Tasking experience is required 

PHYSICAL REQUIREMENTS

  • Physical health sufficient to meet the ergonomic standards and demands of the position.

About Us

Virginia Premier Health Plan, Inc. is a managed care organization which began as a full-service Medicaid MCO in 1995. Partnered with VCU Medical Systems we strive to meet the needs of the underserved and vulnerable populations in Virginia by delivering quality driven, culturally sensitive and financially viable Medicare and Medicaid healthcare programs.  Headquartered in Richmond, VA we also have offices in Roanoke, Tidewater and Bristol with additional satellite locations allowing us to serve over 200,000 members across eighty counties throughout Virginia. 

 

We offer competitive salaries and a comprehensive benefits package to include excellent Medical, Dental and Vision Plans, Tuition Assistance, Infant-At-Work Program, Remote Work options and generous vacation and sick leave policies. Our culture supports an environment where employees can continuously learn and gain professional growth through various development programs, education, exciting projects and career mobility.  

 

All qualified applicants will receive consideration for employment without regard to age, race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status. EOE

 

Our mission is to inspire healthy living within the communities we serve!

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