Manager, Market Quality Improvement - Must Reside in Georgia at CareSource

Job Summary:The Manager, Market Quality Improvement manages the day-to-day prioritization of staff activities in collaboration with Director, Quality Improvement. The Manager will be responsible for developing quality documents in compliance with state and federal requirements and work with departments outside of quality to obtain information for reports.Essential Functions:Responsible for Corporate oversight of the HEDIS Medical Record Review Unit as needed for the assigned marketResponsible for development and oversight of Quality Improvement (QI) Projects and Performance Improvement Projects related to HEDIS and pay for performance (P4P) requirementsEnsures compliance with External Quality Review audits/studies, Performance Improvement Projects, and Quality Improvement Projects required by the state, NCQA, and other accreditation bodiesResponsible for the review of QI issues regarding compliance with Federal, State, and Accreditation requirementsEnsure all policies and procedures are aligned with Federal, State, and Accreditation requirementsResponsible for the annual review, program description, program plan, and update of QI Department policies and proceduresProvide education to internal and external customers on quality improvement functionsRespond to questions that pertain to HEDIS and Quality Improvement from providers and internal staff membersFoster relationships with all internal departments and represents CareSource to community-based and state programsCollaborate with business owners to establish, implement, and develop best practices for P4P quality directivesImplement opportunities for process improvement that impact quality measurements in assigned marketMonitor industry trends as it relates to healthcare and identify areas of opportunity for improvementResponsible for ensuring business owners successfully complete all deliverables related to performance improvement plans (PIPs) and quality improvement plans (QIPs) within defined timeframesConducts analysis, including root cause analyses with support from identified business units and ensure data is presented and used efficiently to meet the quality goalsFollows enterprise standards and procedures for all quality reporting and documentation and communicate areas of strengths as well as needs to the Quality Improvement CommitteePerform all facets of quality management to include the development of detail work plans, setting deadlines, assigning responsibilities and monitoring/summarizing project progressEstablish, monitor and review mechanisms to assess and document each business units level of compliance with each measure and coordinate corrective actionsAttends and participates in market quality committeesGuide and direct successful completion of daily tasks and projectsInterview, select and train new team membersConduct performance management activities for direct reports, to include monthly one-on-one meetings, annual performance appraisals, and discipline as appropriatePerform any other job related instructions, as requestedEducation and Experience:Bachelor's Degree or equivalent years of relevant work experience is requiredCompletion of an accredited Registered Nursing degree program or Bachelor's of Science in Nursing (BSN) is preferredMaster's Degree in Nursing (MSN), Public Health, or healthcare related field is preferredA minimum of three (3) years of experience in a healthcare or managed care organization is requiredPrevious management experience is requiredMedicaid and/or Medicare experience preferredExperience in quality metrics preferredCompetencies, Knowledge and Skills:Intermediate proficiency in Microsoft Word, Excel and PowerPointSolid leadership skills; able to effectively manage a high performing team, provide coaching and developmentDemonstrated ability to adjust and shift priorities, multi-task, work under pressure and meet deadlinesProven ability to recognize opportunity for improvement and lead changeData analysis and trending skillsEffective communication skillsPrior supervisory skillsAbility to work independently & in a team environmentTraining/teaching skillsTime management skillsCritical listening and thinking skillsStrategic management skillsDecision making/problem solving skillsCustomer service orientedLicensure and Certification:Current, unrestricted Registered Nurse (RN) licensure in the state of practice is preferredCertified Professional in Healthcare Quality (CPHG) is preferredWorking Conditions:General office environment; may be required to sit/stand for long periods of timeSome in state travel required (approximately 20% of time)Compensation Range:$81,400.00 - $130,200.00 CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package.Compensation Type:SalaryCompetencies:- Fostering a Collaborative Workplace Culture- Cultivate Partnerships- Develop Self and Others- Drive Execution- Influence Others- Pursue Personal Excellence- Understand the BusinessThis job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.#LI-JM1