Oversees the development, implementation and management of the quality improvement program and meets all regulatory requirements. May be responsible for the oversight and management of HEDIS reporting, facilitating the QI Committee structure, coordinating the preparation for CMS and DOH audits, coordinating delegation oversight, quality consultation to other departments, collecting and analyzing data to identify opportunities for improving member satisfaction and health outcomes, and developing and implementing initiatives to address those opportunities. Leads quality improvement initiatives. May manage compliance submissions and responses.
Required Experience
Minimum Requirements
Extensive knowledge of Quality program implementation and management, Medicare, HEDIS, Pay for Quality or similar physician bonus programs, and Delegation oversight program activities; Minimum of six years experience working in managed care with emphasis in quality improvement; Minimum of three years of experience in managing HEDIS process. Preferred Requirements: Bachelor in health related field. Registered Nurse degree, with an active, unrestricted nursing license in the state.
