Submit Application and Resume to Alliance Health at https://www.alliancehealthplan.org
Reference Requisition DIREC001779
The Director of Quality Management develops strategies to drive continuous improvement through all levels of the organization. The Director works with other departments/divisions on the development of key metrics, data gathering, and compliance with quality system standards to align continuous improvement efforts with organization strategies and initiatives.
This position will allow the successful candidate to work a primarily remote schedule. They must reside in North Carolina and will be required to come into the Alliance office in Morrisville or Charlotte, NC, for meetings with staff as needed.
Responsibilities & Duties
Develop and Implement Department goals and objectives
- Work with the SVP of Quality Management to establish and implement department goals and objectives.
- Work with the SVP of Quality Management to develop a quality management plan that defines and describes quality standards and assessments
- Research and incorporate best practices into quality management operations
- Analyze, updates, and modifies standard operating procedures and processes to continually improve department operations
- Oversee all regulatory body surveys; record concerns and develop procedures to handle concerns identified from survey data
Staff Management and Development
- Work with Human Resources and the SVP of Quality Management to maintain and retain a highly qualified and well-trained workforce
- Ensure staff are well trained in and comply with all organization and department policies, procedures, and business processes
- Organize workflows and ensure staff understand their roles and responsibilities
- Ensure the department has the needed tools and resources to achieve organizational goals and to support employees and ensure compliance with licensure, regulatory, and accreditation requirements
- Actively establish and promote a positive, diverse, and inclusive working environment that builds trust
- Ensure all staff are treated with respect and dignity
- Ensure standards are transparent and applied consistently, impartially, and ethically over time and across all staff members
- Work to resolve conflicts and disputes, ensuring that all participants are given a voice
- Set goals for performance and deadlines in line with organization goals and vision
- Effectively communicate feedback and provide ongoing coaching and mentoring to staff and support a learning environment to advance team skills and professional development
- Cultivate and encourage efforts to expand cross-team collaboration and partnership
Collaborate with internal and external stakeholders on quality measurement/ performance initiatives
- Lead efforts on and collaborate with others on Healthcare Effectiveness Data and Information Set (HEDIS) performance
- Collaborate with state of North Carolina leaders on quality initiatives
- Review and implement new technological tools and processes and foster a team concept with internal and external stakeholders
- Support and collaborate with other leaders on Health Plan National Committee for Quality Assurance (NCQA) Accreditation and others
- Oversee quality improvement aspects of risk adjustment processes for all products
- Work collaboratively with other departments/divisions on the development of key metrics, continuous improvement, and compliance with quality system standards
- Oversee performance and outcome measurement activities including tracking key indicators throughout the year, aggregating data, analyzing quarterly and annual trends, and working collaboratively with program staff regarding follow-up activities and improvements, as required
- Work collaboratively with departments to identify opportunities to redesign processes that meet principles of enhanced effectiveness and efficiency within the organization
- Work with internal departments to support the Data Science team’s introduction of machine learning techniques, such as the automatic interpretation of multiple text fields in databases to reach decisions
- Collaborate with the provider network staff on gaps analyses and strategic planning
Oversee development of quality improvement data gathering and reporting
- Present quality initiative findings and results of improvement efforts and ongoing performance measures to SVP of Quality
- Streamline the internal reporting process including the management of adhoc reporting request by creating an internal systematic process
- Oversee appeals and grievance trending and reporting and collaborate with other leaders to mitigate risk
- Oversee analyses of data related to deviations of good clinical practice (GCP), including development of clear hypotheses and use of appropriate statistical analyses utilizing data from disparate sources (databases/tables) to develop actionable insights that support continuous process improvement
- Oversee efforts to automate the generation of Dashboards and Reports
- Develops, collects, prepares and analyzes quality of care data using computer designed data retrieval and storage; coordinates activities with the information technology department to collect information that can be used to examine patterns of outcomes of service delivery
Minimum Requirements
Education & Experience
- Registered Nurse Required (Medicaid experience preferred)
- Master’s degree in Nursing, Quality Management, Health Management or Healthcare related field required
- Five (5) years’ demonstrated Statistics/analytics and/or quality management/quality improvement experience in a managed care environment preferred
- Five (5) years of experience in a clinical healthcare setting
- Three (3) years or more management experience.
- Training in data analysis, project planning or quality management is a plus.
- Analysis tools such as SAS/SPSS/R, data storage principles and SQL is a plus
Knowledge, Skills, & Abilities
- Thorough knowledge of public administration principles and methods, including goal setting, program development and administration, budgeting, and staff supervision
- Thorough knowledge of laws, rules and regulations governing LME/MCO activities and standards;
- Thorough knowledge of laws, rules and regulations governing LME/MCO activities and standards;
- Knowledge of the social, political and economic issues including available public and private community resources;
- Knowledge of principles of management and administration including planning, budgeting, human resource management, finance, and computer applications
- Experience with project management, lean, DMAIC, Six Sigma, Kaizen PDCA cycles, Pareto analysis, techniques for statistical analysis, survey design and methodologies, and training
- Extensive knowledge and understanding of business processes analysis and enhancing operations to accomplish business objectives
- Knowledge of the organization and functions of departments and agencies which comprise county government
- Strong analytical skills and ability to solve complex technical problems
- Familiarity with software programs (Word, Excel, Access, Visio, PowerPoint, and statistical software packages like SAS, SPSS, or R) as well as an understanding of data storage principles and SQL is necessary
- Ability to lead and motivate staff
- Ability to develop and implement goals, objectives, policies, procedures, work standards and internal controls
- Ability to analyze complex administrative and regulatory problems, evaluate alternatives and adopt effective courses of action
- Ability to prepare clear and concise reports, correspondence and make effective presentations
- Ability to exercise sound independent judgment within general policy guidelines
- Ability to develop proposals and programs which respond to long- and short-range problems detected during analysis
- Ability to develop proposals and programs which respond to long- and short-range problems detected during analysis
- Ability to comprehend and analyze complex organizational and procedural problems involving work production, work flow, forms, records, systems and staff utilization
- Ability to prepare and interpret a variety of reports, charts, layouts and other materials using computer and information services technology
- Ability to enlist the cooperation of officials of various agencies to implement policy and procedural changes
- Ability to present ideas effectively, both orally and in writing
Salary Range
$75,438.27 to $129,865.03/Annually