Director of Quality Management

Reporting to the Corporate Director of Quality Management, this position is responsible for coordination and/or actually performing all the activities associated with accreditation of the specific SA programs. The incumbent ensures that the accreditation process is performed timely and accurately. In addition, the incumbent is responsible for selected functions for all of the SAI and its Health Plan affiliates. These selected functions are related to areas for credentialing, delegation, and other quality improvement activities.The incumbent will also collect, review and analyze Corporate Health Plan affiliates’ Quality data. The position oversees the monitoring activities of delegations for national corporate contractors and monitors the Health Plan delegation process. This includes gathering of statistical data and conducting reviews as required. It is also responsible for the collection and coordination of analysis and distribution of Quality data and reports to health plan(s). The incumbent utilizes medical knowledge and analytical and technology skills to effectively carry out activities in the corporate Quality Department.Essential Functions:
Acts as liaison with the accreditation organization(s), and interacts with all levels of management within Schaller Anderson and its affiliates. Performs operational oversight and administrative activities that drive accreditation process, while applying analytical and quality management principals to efficiently carry out activities related to the accreditation process.Performs project management of the accreditation process, to include the development, implementation and execution of the work plan. Participates and oversees the documentation preparation for the accreditation application(s), and provides recommendations and/or initiatives that will improve and streamline accreditation activities.Develops operational systems that facilitate data collection, analysis, tracking and trending in preparation for initial accreditation application submission and subsequent site visit.Oversees consistency of compliance monitoring of national delegations contracts and delegated organizations within the Health Plan.Provides technical assistance to Health Plans related to development of studies, including expected benchmarks, data sources and outcomes.Coordinates with the Health Plan review, and evaluation and development of an action plan related to the annual member and provider surveys under the leadership of the Director.Prepares the Corporate Annual Quality Management Report (based on the Health Plan annual evaluation reports).Secondary Functions:Stays current on all local and national Quality trends; analyzes patterns that impact the efforts of Quality monitoring activities.Develops progress reports and corrective action plans for meeting accreditation standards and report to corporate director of quality management.Researches, develops and revises policies and procedures, standards, to maintain currency with quality management and the accreditation standards and practices.Works collaboratively with Disease Management (DM) and other departments to develop population based measurements to demonstrate outcomes of the DM programs.Works in a manner that is not disruptive to peers, supervisors and/or subordinates.Maintains regular and acceptable attendance at such level as is determined in the employer’s sole discretion.Maintains availability and willingness to work such days and hours as the employer determines are necessary or desirable to meet its business needs.Maintains availability and willingness to travel to such locations and with such frequency as the employer determines is necessary or desirable to meet its business needs (if travel required).Knowledge and Skills:
Requires tact, insight, leadership and good interpersonal skills. Effective oral and written communication skills, the ability to manage several tasks/projects simultaneously, and analytical skills are necessary to perform successfully in this role. The ability to successfully utilize Microsoft Office Suite and common computer and office hardware is necessary. Project management skills, including implementing project management philosophies and work plan development using Microsoft project are required.Education and Work Experience:
Minimum of two years of consulting and/or project management experience in health care, including one year experience with managed care and/or quality measurement and the accreditation process. Continuous Quality Improvement theory and practice familiarity preferred. Minimum of three years’ experience in health care in a managed care environment. Minimum of three years’ experience in healthcare quality assurance and/or accreditation. (e.g. NCQA, URAC, JCAHO) Prefer a current RN license in the State of Arizona, with a Bachelor of Science in Nursing, or a clinical, management or business related field.
Work Environment Qualifications:
Position is an office environment. Incumbent may be required to sit for extended periods, entering and manipulating data on a workstation computer and participating in team/executive meetings. Approximately 75% of daily responsibilities will be working both one-on-one and in teams with other personnel and extended one-on-one contact in a quiet environment where hearing and listening is paramount. Occasional requirements are to: stand, walk, use hands to manipulate, handle or feel objects, tools, or controls, reach with hands and arms, stoop, kneel, and lift/move up to 25 pounds. Incumbent may be scheduled to work an alternate schedule to accommodate essential business needs.