Job Description

Quality Manager

The Quality Manager will be responsible for creation and facilitation of training strategies. Programs to support an operational team. Responsible for abstraction of NCQA HEDIS Measures, CAPHS and HOS surveys to ensure operational milestones, gap closures, and overall success quality standards are attained and maintained.

In this role, the Manager will be expected to perform audits on all medical records and review the data to ensure records are accurate and able to assess the quality of patient care. It is crucial for the Quality Manager to have knowledge of CMS stars rating process, including, NCQA Quality measures, CAHPS and HOS programs and clinical standards and outcomes.

Essential Job Functions

• Manages, coordinates, and facilitates HEDIS Abstraction process by developing training, tools, and workflows to ensure all measures meet or exceed payor targets.
• Coordinates training related to external client facing programs; develops program success measures and performs periodic assessments or program success
• Assures compliance with corporate QI work plans.
• Assures that all QI activities are relevant to the needs of targeted population.
• Work Collaboratively with internal/external vendors
• Maintains effective documentation of research programs to meet regulatory and Accreditation Standards
• Provides oversight to assure accurate and complete qualitative analysis of clinical data and presentation of data analysis results.
• Develops, implements and oversees CAHPS and STAR measures quality metrics.
• Documentation detailing quality measures.
• Responsible for keeping our EHR/EMR system up to date
• Identified and correct any patient's information error
• Quality Spreadsheet
• CDSS/Alerts
• Quality Global Alerts

Minimum Required Education, Experience & Skills

• Must complete at least a two-year associates degree through a technical school or community college.
• Two years of EHR/EMR system experience (NexGen, Athena or similar system experience preferred).
• 5+ years clinical healthcare experience.
• 4-5 Stars Rating/Medicare quality measures (HEDIS, CAHPS, HOS) experience.
• Previous experience working with HEDIS Abstraction software and processes.
• RN or LVN/LPN License in the state to Texas

Preferred Education, Experience & Skills

• Relationship Management skills.
• Effective written/verbal communication.
• Ability to effect or advocate for change.
• Perform critical clinical analysis.
• Plan and organize effectively reports.

Physical & Mental Requirements (check all that apply)

• Required immunizations and vaccinations.
• Ability to lift upwards of 50 pounds.
• Ability to push or pull heavy objects using up to 100 pounds of force.
• Ability to stand or sit for extended periods of time.
• Ability to use fine motor skills to operate equipment and/or machinery.
• Ability to properly drive and operate a company vehicle.
• Ability to receive and comprehend instructions verbally and/or in writing.
• Ability to use logical reasoning for simple and complex problem solving.
• Occasionally requires exposure to communicable diseases or bodily fluids.
• Ability to discriminate shades of color when reading a dipstick.

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