AmeriHealth Caritas Supervisor, Quality Management in Baton Rouge, Louisiana

Supervisor, Quality Management


Description

Your career starts now. We’re looking for the next generation of health care leaders.

At AmeriHealth Caritas, we’re passionate about helping people get care, stay well and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we’d like to hear from you.

Headquartered in Philadelphia, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more about us at www.amerihealthcaritas.com.

Responsibilities:

As part of the Quality Management team, the Supervisor, Quality Management leads the day-to-day execution of one or all of the following functional areas: Quality Improvement Initiatives; HEDIS year-round medical record abstraction, provider outreach and education, and HEDIS performance improvement planning Based on market needs, the Supervisor, Quality Management, may be asked to focus in one or all of the below functional areas. This position is also responsible for managing and developing a team of clinical and non-clinical specialists to support these areas of responsibility.

Quality Improvement:

  • Responsible for providing input into the development of Quality projects and accountable for the execution and documentation of those projects ensuring identification of root cause; with the assistance of the Quality Manager, establishes a work plan to implement interventions.
  • Leads clinical and non-clinical specialists in the implementation of interventions aimed at improving quality performance by:

  • Development and coordination of member and provider communications required for QI initiatives with the Manager of Provider Communications.

  • Collaborates with Quality Management Reporting Supervisor to use data and analysis toolsidentifying opportunities for improved performance and collaborates with peers to develop intervention strategies.
  • Manages abstraction and data acquisition processes to improve HEDIS and state performance scores. Facilitates access to health systems for data retrieval while maximizing efficiency.
  • Communicates regularly and effectively with the QM Manager and Director including analysis and summary reports on HEDIS and abstraction status.
  • Responsible for executing a coordinated strategy for provider outreach targeted to improving state performance measures and other health plan goals.
  • Responsible for the supervision and development of new and existing staff.
  • Travel up to 25% time.

Education/Experience:

  • Bachelor’s Degree or equivalent work experience.
  • 3 years of management or leadership responsibilities in Quality Improvement.
  • 3-5 years of progressively responsible experience in a health care or health plan related position.
  • Managed Healthcare experience preferred.
  • Thorough knowledge of NCQA and state contract requirements.
  • Successful management of NCQA accreditation survey preferred.
  • Demonstrated ability to manage clinical and non-clinical staff.
  • Excellent organizational, analytical, and interpersonal skills.
  • Excellent written and verbal communication skills.
  • Ability to work successfully within all levels of the organization and with Enterprise partners.
  • Ability to design, develop and implement projects to address financial, quality and service improvements.
  • Proficient PC skills in a windows based environment.

EOE Minorities/Females/Protected Veterans/Disabled