Quality Director

Richmond VA 23233

Job Description

The director of quality management develops, implements, and manages the quality management (QM) strategies for the health plan in collaboration with state and national leadership. He/she is responsible for the design, implementation and monitoring of quality programs at the health plan. The director works collaboratively with the National Directors to ensure projects are within scope and meet time, budgetary and regulatory requirements.

●Manages all operational aspects of a project and scope within QM for the health plan 
●Collaborates with business owners and key stakeholders to identify the project’s goals, objectives, critical success factors and measures 
●Develops state work plans and revises as appropriate to meet state, regulatory and accreditation requirements 
●Reviews health plan deliverables for accuracy and state, regulatory and accreditation requirements  
●Responsible for the health plan’s development and implementation of the Trilogy Documents (Program Description, Workplan, and Program Evaluation) 
●Ensures project documents are complete, current, and stored appropriately 
●Participates in health plan project planning and strategy planning as required 
●Provides status reporting to state and national leadership 
●Prepares health plan quality team for and participates in state, regulatory and accreditation surveys 
●Oversee the health plan quality committee structure, including: 
  o Ensures all committee membership appointments (internal and external) as specified in the Quality Improvement program 
  o  Ensures all committees are meeting regularly, presenting required information and tracking action items 
● Develops, implements and monitors the Quality Management program description, work plan, and program evaluation, including assessment of compliance with state, contractual, regulatory and accreditation requirements 
● Implements and modifies the health plan’s QM policies and procedures as necessary to meet state, regulatory and accreditation requirements 
● Reports on the status of the health plan’s quality projects to the state and national leadership 
● Prepares and presents quality updates at Health Plan quality meetings 
● Demonstrates success in implementing QM standards and practices across multi-department healthcare settings 

General Job Information

Title

Quality Director

Grade

29

Job Family

Quality Group

Country

United States of America

FLSA Status

United States of America (Exempt)

Recruiting Start Date

5/1/2019

Date Requisition Created

5/1/2019

Minimum Qualifications

Education

Masters (Required)

License and Certifications - Required

CPHQ - Certified Professional In Healthcare Quality - Care Mgmt

License and Certifications - Preferred

RN - Registered Nurse, State and/or Compact State Licensure - Care Mgmt

Other Job Requirements

Responsibilities

5 to 8 years of experience with management level and supervisory experience

Knowledge of quality improvement processes, performance measurement, accreditation standards, measurement tools, CQI tools and data reporting applications. Knowledge of CQI training and QIA methodology. Demonstrated management and leadership skills. Expertise in data management software including spreadsheet development and use.

Clinical degree. Knowledge of NCQA and URAC standards. Knowledge of statistical analysis procedures and software.

Magellan Health Services is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled. Every employee must understand, comply and attest to the security responsibilities and security controls unique to their position.

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