Manager - Quality Care Improvement *Hybrid*

Quality Care Improvement Team Hybrid, California


Description

Job Title: Manager - Quality Care Improvement    

Department: Quality - Quality Care Improvement    

About the Role:
The QCI manager is responsible for managing staff and the successful planning, implementation and management of quality activities and other related program obligations. The position provides support to the QCI Director and department leadership. The QCI Manager’s role is to serve as the key liaison in coordinating the HEDIS & Quality measures activities, projects and bridge other departments and health plans in the workflow to meet the performance standards and benchmark for all measures.    

What You'll Do:     

  • Comply with department policies and procedures
  • Responsible for the day-to-day department operations, monitoring and compliance of all HEDIS & Quality related activities and performance for all IPAs managed by NMM for Medicaid and CCA/Commercial lines of businesses
  • Model leadership behavior, support team with quality and production goals through coaching, feedback, and development of reporting staff
  • Monitor QI inventory and adjust or help manage workloads and assignments to individuals within the team
  • Provide support for all HEDIS related projects and interventions aimed at improving HEDIS/Quality performance rates
  • Participate and support in ongoing discussions concerning data collections, study design, methodology, and data analysis for HEDIS/Quality projects
  • Support the providers in preparing infrastructure for quality management implementation through activities such as advising on proper documentation, billing, and coding, pre-screening appointments, and helping to improve Medicaid and Commercial/CCA HEDIS scores
  • Facilitate and perform HEDIS/Quality Measure trainings prepared by the department
  • Attend all Health Plan and all other relevant trainings and technical content online seminar training
  • Manage Reporting – generate and maintain accurate weekly and monthly report of QI activities
  • Correspondence – handle provider documents including formal letters, faxes, certified mail and drafting of these documents as required
  • Performs staff hiring and evaluation of performance during introductory and annually
  • Address health plans, provider, and interdepartmental calls in accordance with exceptional customer service; maintain professional and appropriate behavior  (actions/verbal) at all times
  • Performs other duties, projects and actions as assigned in a professional manner, utilizing time and resources efficiently

Qualifications: 

  • Bachelor’s degree or higher degree preferred and/or equivalent experience is highly desired
  • Five years of IPA/MSO/HP or general healthcare experience with management experience preferred
  • Working knowledge of managed care, health plan product lines (HMO, PPO, CCA, Medi-Cal, etc.)
  • Demonstrated ability to conduct and interpret quantitative/qualitative analysis
  • Ability to coach and mentor staff and engage in difficult conversations
  • Demonstrate an understanding of the operations of the program, health policy trends, and any applicable regulations related to the responsible technical area
  • Ability to understands and explain data reports in diverse ways to practitioners
  • Knowledge of, and experience with Medicaid and CCA/Commercial Quality Measure Sets & overall quality improvement methods
  • Proven ability to prioritized and organize multi-faceted/multiple responsibilities simultaneously in a fast paced, changing environment while meeting deadlines and turnaround time requirements
  • Must possess the ability to educate and train provider office staff members
  • Must be able to work independently utilizing all resources available while staying within the boundaries of duties
  • Ability to keep an elevated level of confidence and discretion when dealing with sensitive matters relating to providers, members, business plans, strategies and other sensitive information is required
  • Excellent presentation, verbal and written communication skills, and ability to collaborate with co-workers, senior leadership, and other management
  • Must be ethical and possess the ability to remain impartial and objective
  • Proficient with Microsoft applications
  • Personal & Professional Qualities
    • Punctuality, creativity, self-motivation
    • Professional appearance and conduct
    • Conceptual and “big picture” understanding
    • Able to function independently under time constraints
    • Willing to learn and develop new responsibilities and skills
    • Good organization, critical thinking, and critical thinking skills
    • Must be detail-oriented and able to work autonomously but also as a team member
    • Should have effective, interpersonal communication and customer service skills

You're great for this role if:    

  • You exhibit efficiency, collaboration, candor, openness, and results orientation
  • You are bilingual and fluent in the language spoken and written (example: Mandarin or Spanish)
  • You have experience managing and coaching direct reports
  • You have experience in data analytics

Who We Are:    

Astrana Health (NASDAQ: ASTH) is a physician-centric, technology-powered healthcare management company. We are building and operating a novel, integrated, value-based healthcare delivery platform to empower our physicians to provide the highest quality of end-to-end care for their patients in a cost-effective manner. Our mission is to combine our clinical experience, best-in-class delivery network, and technological expertise to improve patient outcomes, increase access to healthcare, and make the US healthcare system more efficient.     

Our platform currently empowers over 10,000 physicians to provide care for ~1 million patients nationwide. Our rapid growth and unique position at the intersection of all major healthcare stakeholders (payer, provider, and patient) gives us an unparalleled opportunity to combine clinical and technological expertise to improve patient outcomes, increase access to quality healthcare, and reduce the waste in the US healthcare system.     

Our Values:     

  • Put Patients First 
  • Empower Entrepreneurial Provider and Care Teams 
  • Operate with Integrity & Excellence 
  • Be Innovative 
  • Work As One Team 

Environmental Job Requirements and Working Conditions:     

  • Our organization follows a hybrid work structure where the expectation is to work both in office and at home on a weekly basis. The office is located at 1680 S Garfield Avenue #205, Alhambra, CA 91801.
  • This position will require traveling locally up to 25% of the time (conference, clinic/provider engagement, events, etc.)
  • The total compensation target pay range for this role is: $80,000 - $110,000. The salary range represents our national target range for this role. 

Astrana Health is proud to be an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based upon race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. All employment is decided on the basis of qualifications, merit, and business need. If you require assistance in applying for open positions due to a disability, please email us at humanresourcesdept@astranahealth.com to request an accommodation.     

Additional Information:     

The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change.     

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