Description:
CoventryCares of Kentucky is looking for the best and the brightest to join our winning team.
GENERAL SUMMARY
Directs Healthcare Effectiveness Data and Information Set (HEDIS) related quality improvement activities for an assigned region, including medical record review improvement and Coventry-wide interventions to improve HEDIS measures. Establishes strategic plans, policies, and procedures within the region. Interfaces with all business areas to ensure quality programs will meet or exceed guidelines and requirements.
ESSENTIAL RESPONSIBILITIES
- Ensures compliance with all State and Federal quality regulations, Coventry quality standards, and National Committee for Quality Assurance (NCQA) standards related to HEDIS reporting.
- Ensures maintenance of accurate documentation for all quality improvement activities related to HEDIS reporting, i.e., surveys, audits, peer reviews, etc.
- Collaborates with health plan quality management staff to hold regular HEDIS improvement meetings.
- Remains current with new developments in the field of HEDIS quality improvement.
- Develops and implements new HEDIS quality improvement activities within an assigned region.
- Ensures all quality improvement activities are conducted according to Coventry quality standards and all appropriate data and documentation is retained.
- Ensures that quality improvement information, including the monitoring and evaluation of indicators, is collected and reported to the appropriate oversight committees.
- Directs data collection for HEDIS measures; identifies opportunities for improvement based on the HEDIS results.
- Controls expenses while meeting operational, functional, and service requirements.
- Recruits, develops, and motivates staff. Initiates and communicates a variety of personnel actions including employment, termination, performance reviews, salary reviews, and disciplinary actions.
- Performs other duties as required.
Qualifications:
JOB SPECIFICATIONS
- Bachelor's degree or equivalent experience. Master's degree preferred.
- Minimum of 5 years managed care experience with emphasis in quality improvement.
- Previous (3-5 years) HEDIS experience required.
- Minimum of 3 years management/leadership experience required.
- Certified Professional in Healthy Quality (CPHQ) preferred.
- Extensive knowledge of Quality Program implementation.
- Excellent organizational, managerial and analytical skills required.
- Strong understanding of accreditation, federal and state regulations/requirements.We offer competitive salaries and excellent benefits. Coventry Health Care is an Affirmative Action/Equal Opportunity Employer, and we are committed to building a talented and diverse team.
Job: Executive/Senior Level Officials and Managers
Primary Location: Louisville, KY, US
Other Locations: ,
Organization: 38500 - Coventry Health & Life-KY
Schedule: Full-time
Job Posting: 2013-08-06 00:00:00.0
Job ID: 1312537
CoventryCares of Kentucky is looking for the best and the brightest to join our winning team.
GENERAL SUMMARY
Directs Healthcare Effectiveness Data and Information Set (HEDIS) related quality improvement activities for an assigned region, including medical record review improvement and Coventry-wide interventions to improve HEDIS measures. Establishes strategic plans, policies, and procedures within the region. Interfaces with all business areas to ensure quality programs will meet or exceed guidelines and requirements.
ESSENTIAL RESPONSIBILITIES
- Ensures compliance with all State and Federal quality regulations, Coventry quality standards, and National Committee for Quality Assurance (NCQA) standards related to HEDIS reporting.
- Ensures maintenance of accurate documentation for all quality improvement activities related to HEDIS reporting, i.e., surveys, audits, peer reviews, etc.
- Collaborates with health plan quality management staff to hold regular HEDIS improvement meetings.
- Remains current with new developments in the field of HEDIS quality improvement.
- Develops and implements new HEDIS quality improvement activities within an assigned region.
- Ensures all quality improvement activities are conducted according to Coventry quality standards and all appropriate data and documentation is retained.
- Ensures that quality improvement information, including the monitoring and evaluation of indicators, is collected and reported to the appropriate oversight committees.
- Directs data collection for HEDIS measures; identifies opportunities for improvement based on the HEDIS results.
- Controls expenses while meeting operational, functional, and service requirements.
- Recruits, develops, and motivates staff. Initiates and communicates a variety of personnel actions including employment, termination, performance reviews, salary reviews, and disciplinary actions.
- Performs other duties as required.
Qualifications:
JOB SPECIFICATIONS
- Bachelor's degree or equivalent experience. Master's degree preferred.
- Minimum of 5 years managed care experience with emphasis in quality improvement.
- Previous (3-5 years) HEDIS experience required.
- Minimum of 3 years management/leadership experience required.
- Certified Professional in Healthy Quality (CPHQ) preferred.
- Extensive knowledge of Quality Program implementation.
- Excellent organizational, managerial and analytical skills required.
- Strong understanding of accreditation, federal and state regulations/requirements.We offer competitive salaries and excellent benefits. Coventry Health Care is an Affirmative Action/Equal Opportunity Employer, and we are committed to building a talented and diverse team.
Job: Executive/Senior Level Officials and Managers
Primary Location: Louisville, KY, US
Other Locations: ,
Organization: 38500 - Coventry Health & Life-KY
Schedule: Full-time
Job Posting: 2013-08-06 00:00:00.0
Job ID: 1312537