QI Program Manager
Kern Family Health Care, 2900 Buck Owens Blvd., Bakersfield, California, United States of America Req #1539
We appreciate your interest in our organization and assure you that we are sincerely interested in your qualifications. A clear understanding of your background and work history will help us potentially place you in a position that meets your objectives and those of the organization. Qualified applicants are considered for positions without regard to race, color, religion, sex (including pregnancy, childbirth and breastfeeding, or any related medical conditions), national origin, ancestry, age, marital or veteran status, sexual orientation, gender identity, genetic information, gender expression, military status, or the presence of a non-job related medical condition or disability (mental or physical).
Under the direction of the Director of Quality Improvement (QI), the QI Program Manager’s purpose in this role is to manage, plan, coordinate and monitor Quality Improvement Special Programs including but not limited to:
- Annual Managed Care Accountability Set (MCAS) audit and measurement results submission;
- QI Department Strategic Goals,
- QI Department project planning,
- Special Programs (such as member incentives and engagement, DHCS-required project improvement plans, site reviews, etc.), Develop and Organize Ongoing Provider Training, Contract Pricing Software, and PR & Credentialing Department Auditing functions.
The Program Manager possesses project management-like skills for oversight, coordination, planning, management, execution, and finalization of business-related programs that require business resources. This includes skills to conduct program analysis, comprehend technical requirements, define plans for execution, coordinate technical resources assigned to tasks or programs, create program tracking reports, and accurately report to all levels of management on a program(s) status. The program manager can maintain an interdependent relationship with staff, providers and members by providing administrative support on sponsored projects. They have strong written and oral communication skills.
- Provide project management services for the entire MCAS annual audit and data and report submission.
- Identify, coordinate and ensure timely submission of all deliverables. Develop and maintain a project plan for the audit and for submission of all DHCS, EQRO and NCQA deliverables.
- Ensure effective coordination of deliverables between all KHS departments involved with the MCAS audit and submission.
- Manage issues identified within the audit program and facilitate resolution of all issues.
- Escalate issues appropriately and timely to the HEDIS software vendor.
- Escalate issues to QI Department leadership timely and accurately and demonstrates effective problem-solving abilities for identified issues.
- Organize and lead regular meetings with the MCAS audit and data and report submission team, including maintaining meeting agendas and minutes.
- Consult with all departments within KHS to coordinate activities and plan and promote QI Programs.
- Ensures timely and accurate communication with program stakeholders
- Review and ensure regulatory and contractual compliance for QI programs and deliverables.
- Provide coordination and management support for the QI Department in the design, review and testing of system generated processes used within KHS.
- Support the QI management team with work assignments for staff based on workload and operational priorities.
- Work with department leadership on matters related to information processing and reporting;
- Thorough knowledge of and proficiency with Windows based PC systems and Microsoft Word, Excel, Outlook, Access, Visio, and PowerPoint, as well as report-generating software.
- Ability to develop and deliver programmatic and project presentations to a variety of audiences including executive leadership and external government and community partners.
- Implement established departmental controls relative to reporting and information needs;
- Serves as a lead and technical resource to subordinate staff in the planning, implementation and management of QI programs.
- Work closely with the IT Department as needed to ensure proper processing of internal QI data.
- Interview department personnel and research existing procedures and requirements in sufficient detail to yield statistics concerning work volumes, regulatory compliance, and personnel requirements.
- Coordinate the system design between all users and data processing.
- Work with team leads and QI Operations Supervisor to establish quality work controls and audit trails;
- Support generation of and updates to program descriptions, program workplans and program workplans.
- Coordinate/Develop and execute strategic initiatives as assigned.
- Participate in the preparation of business plans, analyses, financial projections, and programmatic and operational reports.
- Remain informed about health care policy in Medicare, Medicaid, insurance, long-term care, and mental health for vulnerable populations.
- Prepare activity reports to inform management of the status and implementation plans of programs, services, and quality initiatives.
- Effectively manage the program budget elevate and/or communicate issues to management and provide alternatives to meet a program deadline or deliverable.
- Demonstrate an analytical aptitude to learn and understand business segment processes, including understanding issues of data integrity, security and confidentiality according to the Health Insurance Portability and Accountability Act (HIPAA).
- Lead and provide oversight to team members and contractors while influencing them to take positive action and accountability for their assigned work.
- Identify and resolve issues and conflicts within the project team; ensure project documents are complete, current, and stored appropriately.
- Perform other job-related duties as assigned.
Education: Bachelor’s degree in Healthcare, Business, Data Science, Project Management or related field from an accredited institution. Master’s degree preferred. Certification or a program certificate in project management highly desired.
- Minimum of two (2) years’ experience in Quality Improvement OR in a health care environment with relevant Quality Improvement experience.
- Minimum of two (2) years’ experience in project management work.
Other: Required travel up to 20%. Possession of valid California Driver’s License and proof of valid State required auto liability insurance.
- Reporting tools,
- Statistical and reporting analysis,
- Policy development,
- Principles and practices of project management,
- Business processes, including operations, delivery models and revenue models
- Medical claims processing and basic diagnostic and service codes (e.g. ICD-10, CPT, HCPCS, etc.).
- Microsoft Office Suite, including Word, Excel, PowerPoint, Visio and Microsoft Project.
- Quality Improvement and applied project management.
- Coordination and problem solving with internal staff as well as external customers.
- Systems analysis and feasibility studies
We are an equal opportunity employer, dedicated to a policy of non-discrimination in employment on any basis.