Manager Quality Management

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 Newtown Square, 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:

Under the direction of the Director, Quality Management, the Manager, Quality Management is responsible for providing oversight, daily administrative management, and direct supervision of the Quality Management team. This position is also responsible and accountable for maintaining the Health Plan’s compliance with all state regulations and NCQA standards for quality activities related to Quality Management. This includes managing medical policy development, quality of care, health promotion, HEDIS interventions, accreditation as well as committee structure and support.

Accountabilities:

• Assists in the development and implementation of the QM program description, QM evaluation, and QM work plan. Identifies opportunities for clinical performance improvement and develops Quality Improvement Initiatives related to clinical performance and other quality activities.
• Participates in the planning, developing, and implementing Health Plan activities related to the HEDIS process, accreditation, quality management programs, and AOP-specific initiatives.
• Maintains current knowledge of the Health Plan’s Policy and Procedures and ensures Program compliance to the governing regulatory body, NCQA Standards and HEDIS. Participates in oversight activities as required by regulatory and accrediting bodies.
• Identifies barriers to project and program success and works toward resolution by informing the accountable executives and presenting plans to resolve the issue when possible. Maintains monitoring of issue until resolution or decision by the accountable executive to discontinue efforts toward resolving the issue.
• Responsible for meeting budget, organizational and departmental goals. Maintains optimal staffing patterns based on current Quality Management budget.
• Works collaboratively with Performance Management to identify educational needs to staff and to maintain appropriate clinical expertise required to successfully perform daily responsibilities. Participates as indicated in the development and implementation of orientation and ongoing educational programs.
• Analyzes quality data from all sources and directs to appropriate committees.
• Ensures the timely creation of project plans, including measurements of outcome and productivity, and reports out progress to key stakeholders.
• Prepares reports and assessments of operational/services as required by departmental, corporate, and/or regulatory requirements. Works collaboratively with the Medical Informatics Department on identifying required data for reporting.
• Provides input into the development of educational material and programs necessary to meet the Health Plan’s business objectives, members’ needs, regulatory guidelines and staff professional development.
• Acts as a liaison for the Health Plan with outside entities, including, but not limited to physicians, hospitals, health care vendors, social service agencies, member advocates, and regulatory agencies.
• Participates in interdisciplinary committees to maintain understanding and participation in projects and policies related to compliance with quality standards and or quality initiatives
• Participates in coordination of internal and external Provider directed communication regarding issues impacting Quality.

Education/Experience:

• Bachelor’s Degree preferred.
• Valid driver’s license required.
• Health care quality certification (i.e. ABQAURP or CPHQ) preferred.
• Nursing license strongly preferred.
• A minimum of 3 years of managerial experience.
• A minimum of 5 years of progressive healthcare experience in a quality management related role.
• Prior managed care experience.
• Knowledge of HEDIS & Quality Improvement activities required.

Our Comprehensive Benefits Package

Flexible work solutions including remote options, hybrid work schedules, Competitive pay, Paid time off including holidays and volunteer events, Health insurance coverage for you and your dependents on Day 1, 401(k) Tuition reimbursement and more.