• Sr. Manager, Quality

    Job Locations US-VA-Glen Allen
    Job ID
    2018-5102
  • About Us

    Don’t just find a job, find your WHY at a purpose-driven organization; discover a career at Virginia Premier.
    By blending quality benefits, affiliating with the world-renowned VCU Health System and offering career-advancing development programs, we allow our employees to focus on the meaningful work of improving and saving the lives of more than 200,000 people throughout the state of Virginia.
     
    At Virginia Premier, we are building an industry leading health care organization through dedicated teams that have heart, provide top-notch quality member services and embrace our mission of inspiring healthy living within the communities we serve. Our vision is to connect people to innovation, quality and affordable health care for all phases of life.
     
    If this sounds like you, read on!

    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 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 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 Virginia Premier 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 quality measure 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 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 or leadership experience preferred (Charge Nurse or Team Lead will be considered)
    • Two or more years of project  or program management experience preferred

    SPECIAL KNOWLEDGE AND/OR SKILLS:

    • Regulatory reporting OR Managed Care experience
    • STAR experience preferred but not required
    • Healthcare Quality Improvement experience
    • Six Sigma Green Belt Completion or CPHQ Certification (Highly Preferred; not required)
    • Proven Medical Record Abstraction Experience (Highly Preferred; not required)
    • Proven Member and Practitioner/Provider Education (Highly Preferred; not required)
    • Excellent writing and verbal communication skills
    • Excellent ability to train and mentor, manage change within the work team
    • Ability to perform medical record review and abstraction, data collection

    WORK BACKGROUND EXPERIENCE:

    • 1 year of quality monitoring and measurement or participation with regulatory reporting such as Medicare, Medicaid, Accountable Care Organization, Bundled Payment, The Joint Commission, etc
    • Healthcare quality experience, participation on a quality improvement team or project or process improvement in the clinical setting
    • Experience with LEAN, Six Sigma or CPHQ certification
    • Experience working collaboratively with multiple disciplines including physicians, allied health, and others
    • Managed Care or Population Health experience preferred

    PHYSICAL REQUIREMENTS

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

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

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