Oversee all related activities for the Quality Improvement functions. Lead and direct process improvement activities for more efficient and streamlined workflow.
- Responsible for all activities related to National Committee for Quality Assurance (NCQA) Accreditation and/or Healthcare Effectiveness Data and Information Set (HEDIS) performance ensuring highest level of accreditation
- Manage all aspects of HEDIS improvement activities, including outreach, incentives, data integrity and chart review
- Review and implement new technological tools and processes and foster team concept with internal and external constituencies
- Present results of improvement efforts and ongoing performance measures and recommend actions plans to senior management
- Research and incorporate quality improvement best practices into operations
- Organize and control activities, methods, and procedures to achieve business objectives
- Formulate and establish policies, operating procedures, and goals in compliance with internal and external guidelines
- Manage and ensure compliance of EPSDT program as well as compliance and turnaround time of grievances and appeals
License/Certification: RN license and Certified Professional in Health Care Quality preferred.