Verda Healthcare, Inc. has a contract with the Center of Medicaid and Medicare Services (CMS) and Texas Department of Insurance for a Medicare Advantage Prescription Drug (MAPD) plan for 2024. We are looking for a Sr. Manager of Quality Management to join our growing company with many internal opportunities.
Are you ready to join a company that is changing the face of health care across the nation? Verda Healthcare, Inc. is looking for people like you who value excellence, integrity, caring and innovation. As an employee, you’ll join a team dedicated to improving the lives of our Medicare members. Our vision incorporates value-based health care that works. We value diversity.
Align your career goals with Verda Healthcare, Inc. and we will support you all the way.
Position Overview
The Sr. Manager Health Care Quality Management will manage the quality program, including regulatory deliverables, HEDIS, CAHPS, HOS activities and reporting and other quality improvement activities. Providing support to staff and communication with departments across the health plan to facilitate quality improvement (QI) projects. Identifies and track activities to improve overall Medicare STAR ratings.
Essential Functions:
Coordinate and monitor quality improvement and organizational projects from inception to closure including Healthcare Effectiveness Data and Information Set (HEDIS) preparation. Manage assigned quality improvement projects and be an active participant in internal/external facing meetings.
Responsibilities:
- Prioritizes and makes recommendations for the design, development, and implementation strategy of quality improvement projects, and initiatives.
- Has responsibility for decision making regarding the design, development, and implementation strategy of quality improvement projects, and initiatives.
- Provide functional and technical knowledge for HEDIS across all departmental staff and deliver educational sessions to internal staff and external constituents as needed.
- Coordinate and implement interventions to increase HEDIS, CAHPS, improvement projects and designated health measures for the Plan.
- Develops documentation templates and systems to support QM projects and initiatives.
- Support the coordination of corporate compliance and external surveys as needed.
- Support the project life cycle including requirements gathering, creation of project plans and schedules, manage resources, support HEDIS audit process, and facilitate project execution, deployment, and closure.
- Coordinate all data pulls and ongoing data management for HEDIS and QI project management databases for identified QI projects.
- Participate in vendor oversight meetings with contracted vendors.
- Forms and leads cross functional teams to assist business units in integrating quality into their strategic and operational plans.
- Develops, implements, and evaluates the organization’s policies and procedures to meet business needs.
- Coordinate and implement interventions to enhance HEDIS collection, CAHPS, HOS, STAR rating and improvement projects and designated health measures for the Plan.
- Develops methods and/or tools to collect and track barriers for targeted members and/or providers.
- Assists in the development/update/tracking of departmental policies and procedures.
- Responsible for management/maintenance and completion of assigned workplans, such as QM workplan, HEDIS Roadmap workplan and other workplans as needed to comply with regulatory requirements.
- Provide quarterly updates on assigned projects in the Quality Improvement work plan; may be required to draft presentations on project status and/or outcomes.
Minimum Qualifications
- 5-7+ years clinical and/or managed care experience in the healthcare industry and quality management preferred.
- Clinical licensure: RN (BSN Preferred).
- 3-5 years of Management experience.
Professional Competencies
- Certified Professional in Healthcare Quality (CPHQ) preferred.