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Security Health Plan – Director of Health Plan Quality
Position Title: Director of Health Plan Quality
Position No: 2094
The Director of Health Plan Quality is accountable for successful achievement of quality accreditation for the business lines, measured by various external stakeholders such as the Centers for Medicare & Medicaid Services (CMS) star ratings and the National Committee for Quality Assurance (NCQA). This position manages staff and provides initiatives supporting the strategic and operational goals of the organization and manages the appeals and grievance functions for Security Health Plan (SHP).
ESSENTIAL JOB FUNCTIONS
- Regular attendance is an essential requirement of the position.
- Integrates quality activities across Security Health Plan (SHP) to promote optimal organizational effectiveness and improve operational processes.
- Focuses on cost of care, quality health outcomes, and member experiences to promote quality outcomes.
- Develops and implements policies, procedures and programs to comply with accreditation standards and achieve and maintain successful accreditation and quality recognition.
- Identifies areas for quality improvement initiatives to monitor benchmarks and improve the organizations performance.
- Delivers presentations to stakeholder audiences, including serving as the SHP Quality Improvement Committee chair, to ensure continuous improvement of organizations performance.
- Provides leadership and guidance to designated staff to ensure functions are completed to maintain regulatory compliance.
- Provides education to staff on industry quality measures to ensure compliance with accreditation requirements.
- Maintains knowledge of accreditation agency requirements to successfully implement principles and guidelines throughout the organization.
- Coordinates and facilitates workgroups to implement changes related to accreditation and external review issues.
- Other duties as assigned.
Education qualifications must be from a school whose accreditation is recognized by Marshfield Clinic.
Required Education: Bachelor’s Degree in public health, wellness, nursing, healthcare administration, management or related field
Preferred Education: Master’s Degree in public health, wellness, nursing, healthcare administration or management
Minimum Experience Required: Seven years’ experience with healthcare operations. Knowledge of quality initiatives, business metric development and measurement processes. Three years of management experience.
Preferred/Optional Experience: Experience with National Committee for Quality Assurance (NCQA) or Utilization Review Accreditation Commission (URAC) accreditation.
The following licensure(s), certification(s), registration(s), etc., are required for this position, which must be maintained in good standing:
Minimum Required: If applicable, current State of Wisconsin Registered Nurse license and maintain throughout employment
Exclusion from Federal Programs
Employee may not at any time have been or be excluded from participation in any federally funded program, including Medicare and Medicaid. This is a condition of employment. Employee must immediately notify his/her manager or the Clinic’s Compliance Officer if he/she is threatened with exclusion or becomes excluded from any federally funded program.
- Customer & Patient Focus
- Professionalism & Self Development
- Effective Communication
- Sit with back support continuously (67 – 100%)
- Walk, stoop, bend, crouch, reach, climb occasionally (11 – 33%)
- Lift and carry up to 10 pounds occasionally (11 – 33%)
- Push/pull up to 25 pounds seldom (1 ‐ 10%)
- Work performed in a professional office setting using standard office equipment with internal and external customer contact. Professional dress required.
- Occasionally work weekends and evenings. Some travel and overnight stays necessary.
The above statements are intended to describe the general nature and level of work being performed by the person assigned to this position. Essential job functions are intended to describe those functions that are essential to the performance of this job, and additional job functions include those that are considered incidental or secondary to the overall purpose of this job.
This job description does not state or imply that the above are the only duties and responsibilities assigned to this position. Employees holding this position will be required to perform any other job-related duties as requested by management. All requirements are subject to possible modification to reasonably accommodate individuals with a disability.
To apply for this position, please use the following link: https://marshfieldcliniccss.igreentree.com/CSS_External/CSSPage_JobDetail.ASP?T=20150518115404&. You may also visit the careers page of the Marshfield Clinic at: https://www.marshfieldclinic.org/careers.