Mgr Quality Management

Health Net, Inc. (NYSE: HNT) is among the nation's largest publicly traded managed health care companies. Health Net's mission is to help people be healthy, secure and comfortable. The company's POS, HMO, insured PPO, behavioral health and government contracts subsidiaries provide health benefits to more than 7 million individuals. For more information on Health Net, Inc., please visit the company's Web site at www.healthnet.com



JOB SUMMARY:



Coordinates the activities of the Quality Improvement Department to ensure compliance with NCQA, DHS, CMS, DMHC, MRMIB, and other accreditation and regulatory standards. Ensures development, implementation, monitoring and interventions are completed for quality improvement activities for all product lines. Works with Research & Analysis Department to monitor clinical and service performance indicators, member and provider satisfaction surveys, and access & availability measures. Identifies opportunities for clinical and service improvements for all product lines and works with appropriate departments to initiate interventions. Works with associated departments to implement meaningful and effective interventions. Participates in collaborative initiatives, such as CCHRI, DHS, immunization registries, etc.. and evaluates data from these programs to initiate improvement activities that meet the goals of the Quality Improvement Program. Develops and manages QI work plan and semi-annual evaluations. Coordinates staff resources and develops department budgets (both for Commercial/Medicare QI and SHP QI).



ESSENTIAL DUTIES AND RESPONSIBILITES:

Coordinates staff resources and activities to fulfill the goals of the Quality Improvement Program for all products.Manages preparation of semi-annual Quality Improvement Program Evaluations and Work Plan.Develops and updates the QI Program and policies and procedures for the Quality Improvement Department.Identifies clinical and service improvement activities, develop action plans/interventions/budget, implement activities and monitor effectiveness.Supervises and coordinates department preparations of QI standards for NCQA, DHS, DMHC, MRMIB & CMS, health plan and other audits.Prepares and presents committee reports and project updates to QI committees and work groups as needed.Represents Health Net at corporate committees, collaboratives and external stakeholder meetings.Manages ad hoc projects and represents the QI Department on project teams, as required.Monitors the performance of Quality Improvement staff and initiates modifications that enhance and improve department and program operations.Analyzes programs, initiatives and interventions and make recommendations to improve established performance measures, including HEDIS, CAHPS, PAS, provider satisfaction, access, availability, and coordination of care between medical and behavioral health and between medical settings.Effectively applies, interprets and communicates policies, procedures, regulations and standards. Prepares presentations, data, reports and other materials for committee activities, as needed.Manage department associates, including orientation, performance evaluation, training, motivation, counseling and performance management. REQUIREMENTS


REQUIREMENTS:



Education:



Bachelor's Degree required, Masters of Public Health or Health Care Administration Degree preferred.



Certification/Licensure:



Current license as a Registered Nurse at BSN level or MPH with pertinent quality improvement and professional experience.



Experience:

Three-five years experience in a managed care setting, preferably in Quality Improvement.

Experience in compliance, accreditation, service improvement or quality improvement required.

Three years management experience with direct supervision of staff.

Knowledge, Skills and Abilities:

Knowledge of NCQA and HEDIS guidelines, DHS, DMHC and CMS regulations. Excellent oral and written communications skills with strong analytical and problem solving skills. Able to operate PC-based software programs. Able to analyze, apply, interpret and communicate policies, procedures and regulations effectively. Leadership and management skills to develop associates, coordinate work groups and effectively promote department activities.



Any combination of academic education, professional training or work experience, which demonstrates the ability to

perform the duties of the position.



Health Net, Inc. supports a drug-free work environment and requires pre-employment background and drug screening.



Health Net and its subsidiaries are an Equal opportunity/Affirmative Action Employer M/F/V/D.