Description:
GENERAL SUMMARY
Manages the quality improvement function, including one or more of the following: provider relations, health services, customer service, and/or credentialing. Responsible for ensuring compliance with State regulations and national accrediting body requirements.
ESSENTIAL RESPONSIBILITIES
- Responsible for compliance with State and Federal quality regulations. Ensures all quality improvement activities are conducted according to regulatory guidelines and principles.
- Oversees the maintenance of accurate documentation of all quality improvement activities, i.e., surveys, audits, peer reviews, etc.
- In conjunction with senior medical management, prepares the agenda and manages the activities of the Quality Improvement Committee.
- Develops new quality improvement activities to improve the quality of care and service in the most efficient manner.
- Oversees the annual Medical Record Documentation/Preventive Services clinical study.
- Ensures all departments including credentialing, provider relations, health services, and customer service collect and report quality improvement information to the Quality Improvement Committee, including the monitoring and evaluation of indicators.
- Directs data collection for Healthcare Effectiveness Data and Information Set (HEDIS) measures. Identifies opportunities for improvement based on HEDIS results.
- Remains current with new developments in the field of quality improvement.
- Provides input into department budget. Controls department expenses while meeting 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.
- Previous (3-5 years) clinical or health education experience required.
- Previous (2+ years) quality improvement experience required.
- Previous supervisory or project management experience required.
- Certified Professional in Health Quality (CPHQ) preferred.
- Excellent organizational, analytical, and problem solving skills.
- Excellent verbal and written communication skills.
- Proficiency in data analysis and presentation; ability to analyze and explain health care quality and cost information.
DISCLAIMER: The above statements are intended to describe the general nature and level of work being performed by individuals assigned to this position. They are not intended to be construed as an exhaustive list of responsibilities, duties and skills required of personnel so classified.
Job: First/Mid Level Officials and Managers
Primary Location: Louisville, KY, US
Other Locations: ,
Organization: 38500 - Coventry Health & Life-KY
Schedule: Full-time
Job Posting: 2013-11-05 00:00:00.0
Job ID: 1313499
GENERAL SUMMARY
Manages the quality improvement function, including one or more of the following: provider relations, health services, customer service, and/or credentialing. Responsible for ensuring compliance with State regulations and national accrediting body requirements.
ESSENTIAL RESPONSIBILITIES
- Responsible for compliance with State and Federal quality regulations. Ensures all quality improvement activities are conducted according to regulatory guidelines and principles.
- Oversees the maintenance of accurate documentation of all quality improvement activities, i.e., surveys, audits, peer reviews, etc.
- In conjunction with senior medical management, prepares the agenda and manages the activities of the Quality Improvement Committee.
- Develops new quality improvement activities to improve the quality of care and service in the most efficient manner.
- Oversees the annual Medical Record Documentation/Preventive Services clinical study.
- Ensures all departments including credentialing, provider relations, health services, and customer service collect and report quality improvement information to the Quality Improvement Committee, including the monitoring and evaluation of indicators.
- Directs data collection for Healthcare Effectiveness Data and Information Set (HEDIS) measures. Identifies opportunities for improvement based on HEDIS results.
- Remains current with new developments in the field of quality improvement.
- Provides input into department budget. Controls department expenses while meeting 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.
- Previous (3-5 years) clinical or health education experience required.
- Previous (2+ years) quality improvement experience required.
- Previous supervisory or project management experience required.
- Certified Professional in Health Quality (CPHQ) preferred.
- Excellent organizational, analytical, and problem solving skills.
- Excellent verbal and written communication skills.
- Proficiency in data analysis and presentation; ability to analyze and explain health care quality and cost information.
DISCLAIMER: The above statements are intended to describe the general nature and level of work being performed by individuals assigned to this position. They are not intended to be construed as an exhaustive list of responsibilities, duties and skills required of personnel so classified.
Job: First/Mid Level Officials and Managers
Primary Location: Louisville, KY, US
Other Locations: ,
Organization: 38500 - Coventry Health & Life-KY
Schedule: Full-time
Job Posting: 2013-11-05 00:00:00.0
Job ID: 1313499