Director, Quality Management, Health Plans

Richmond VA 23233

Job Description

The Director, Quality Management develops, implements, and manages the quality management (QM) strategies for the Magellan Complete Care of Virginia health plan in collaboration with state and national leadership. The Director 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.

Essential Functions

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  • 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: ensuring all committee membership appointments (internal and external) as specified in the Quality Improvement program and ensuring 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

Director, Quality Management, Health Plans

Grade

29

Job Family

Quality Group

Country

United States of America

FLSA Status

United States of America (Exempt)

Recruiting Start Date

11/11/2019

Date Requisition Created

11/6/2019

Work Experience

Healthcare, Health Plans, Managed Healthcare, Management/Leadership

Education

Bachelors (Required), Masters

License and Certifications - Required

License and Certifications - Preferred

CPHQ - Certified Professional In Healthcare Quality - Care Mgmt, RN - Registered Nurse, State and/or Compact State Licensure - Care Mgmt

Other Job Requirements

Responsibilities

Preferred Qualifications

  • Master's Degree 
  • Registered Nurse or appropriate clinical licensure 
  • CPHQ
  • Demonstrated experience in leading significant cross-functional work 
  • Excellent knowledge of HEDIS, Medicare STARS and Medicaid 
  • Conceptual and in-depth knowledge of the healthcare industry 
  • Ability to manage relationships with an emphasis on internal and external mid-level relationships 
  • Ability to work across all levels of the organization, including working with executive audiences, vendors and the government as a customer 
  • Project management experience 
  • Internal and external audit experience 

Required Qualifications

  • Bachelor’s degree in Business Administration or related discipline. 
  • 7+ years of demonstrated understanding of healthcare industry standards and HEDIS 
  • Minimum 3 years experience in managed care 
  • Minimum 3 years experience in health plan quality improvement or equivalent experience 
  • Proficient in Microsoft Office tools 
  • Strong analytical skills and strategic thinking 
  • Strong communication skills, both verbally and written 
  • Ability to interact effectively with Business owners, senior management, and peers across the organization 

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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