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Senior Director Quality Improvement-Atlanta, GA - Wellcare Health Plans

Company: Wellcare Health Plans
Location: Atlanta
Posted on: September 15, 2019

Job Description:

Senior Director, Quality Improvement:Located in Atlanta, GA.Plans, develops and directs Quality Improvement functions and activities. Provides leadership necessary to achieve national best practice performance levels in quality improvement programs while implementing evidence based medicine/practice solutions. Ensures that the quality of healthcare services rendered meets or exceeds professionally recognized national and community standards. Interfaces with a diverse range of clinical and administrative professionals, resolves sometimes-complex policy and service issues within the group and directs data analytic and reporting activities that are prescribed by customers and regulators in a complex environment. Ensures compliance with state, federal and accreditation requirements.Reports to: State PresidentDept.: Heath Services QILocation: Atlanta, GAEssential Functions:Develops and implements the quality improvement plans and activities within national/regional markets in accordance with the mission and strategic goals of the organization, federal and state laws and regulations, and accreditation standards.Establishes professional relationships with state, stakeholders, and community agencies to facilitate quality process internally and externally.Develops and implements systems, policies, and procedures for the identification, collection, and analysis of performance measurement data.Analyzes, updates, and modifies standard operating procedures and processes to continually improve QI Department services/operations.Assists in strategizing and facilitating various committee structures and functions to best address the QI process and oversees Quality Committees.Oversight and interface internally and externally with pay for performance programs and initiativesCoordinates and completes all QI activities required to meet national accreditation and regulatory performance improvement initiatives.Supervises teams with overall responsibility for providing support for clinical quality initiatives and regulatory/contractual requirements. Support includes telephonic and in-person outreach as identified as requiring outreach. In addition, to provide assistance to clinical compliance staff with member education, quality management, and Health Promotion initiatives and performance data collection and recording.Collects and summarizes regional market performance data, identifies opportunities for improvement, and presents findings quarterly to the Performance Improvement CommitteeDevelops strategies for special program participation and Quality Improvement. Develops systems for close coordination of QI related functions with departments whose activities are directly a part of the QI Program, including Credentialing.Supervises QI Specialists in the implementation of performance initiatives to drive HEDIS performance and contract compliance quality performance.Communicates new state, federal and third party regulations and requirements to the staff.Facilitates strategic and tactical planning for the quality improvement program, including needs assessments, evaluations, root cause analysis and interventions.Collaborates with Health Services, Operations, and Information Technology departments to ensure full integration of quality improvement reporting for contract and accreditation complianceParticipates in site visit preparation and execution by regulatory and accreditation agencies (state agencies: URAC,NCQA,CMS,AAAHC,EQRO)Leads, facilitates, and advises internal quality improvement teamsActively participates on, or facilitates committees such as: Quality Improvement, Utilization Management, PatientSafety, and Risk ManagementResponsible for monitoring and evaluating staff performance. Additional Responsibilities:Candidate Education:Required A Bachelor's Degree in HealthCare, Nursing, Public Health, Health Administration or directly related fieldPreferred A Master's Degree in a related field Candidate Experience:Required 10 years of experience in directly related Quality Improvement job dutiesRequired 5 years of experience in managed healthcareRequired 5 years of management experienceRequired Other Excellent knowledge of JCAHO, URAC, AAAHC and NCQA standardsPreferred Other Experience in Medicaid/Medicare Candidate Skills:Advanced Knowledge of community, state and federal laws and resourcesAdvanced Demonstrated written communication skillsAdvanced Demonstrated interpersonal/verbal communication skillsAdvanced Demonstrated analytical skillsAdvanced Demonstrated problem solving skillsAdvanced Ability to multi-taskAdvanced Ability to work in a fast paced environment with changing prioritiesAdvanced Ability to effectively present information and respond to questions from families, members, and providersAdvanced Ability to effectively present information and respond to questions from peers and managementAdvanced Ability to communicate and make recommendations to upper managementAdvanced Ability to lead/manage othersAdvanced Ability to drive multiple projectsAdvanced Demonstrated leadership skills Licenses and Certifications:A license in one of the following is required:Required Other For FL/IL/MO/NJ/NE, a current unrestricted RN licensePreferred Licensed Registered Nurse (RN)Preferred Cerified Professionals in Healthcare Quality (CPHQ) Technical Skills:Required Intermediate Microsoft ExcelRequired Intermediate Microsoft WordRequired Intermediate Microsoft VisioRequired Intermediate Microsoft PowerPointRequired Intermediate Microsoft OutlookRequired Intermediate Microsoft AccessRequired Intermediate Healthcare Management Systems (Generic)About usHeadquartered in Tampa, Fla., WellCare Health Plans, Inc. (NYSE: WCG) focuses primarily on providing government-sponsored managed care services to families, children, seniors and individuals with complex medical needs primarily through Medicaid, Medicare Advantage and Medicare Prescription Drug Plans, as well as individuals in the Health Insurance Marketplace. WellCare serves approximately 5.5 million members nationwide as of September 30, 2018. WellCare is a Fortune 500 company that employs nearly 12,000 associates across the country and was ranked a "World's Most Admired Company" in 2018 by Fortune magazine. For more information about WellCare, please visit the company's website at www.wellcare.com. EOE: All qualified applicants shall receive consideration for employment without regard to race, color, religion, creed, age, sex, pregnancy, veteran status, marital status, sexual orientation, gender identity or expression, national origin, ancestry, disability, genetic information, childbirth or related medical condition or other legally protected basis protected by applicable federal or state law except where a bona fide occupational qualification applies. Comprehensive Health Management, Inc. is an equal opportunity employer, M/F/D/V/SO.

Keywords: Wellcare Health Plans, Atlanta , Senior Director Quality Improvement-Atlanta, GA - Wellcare Health Plans, Healthcare , Atlanta, Georgia

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