BLEHEALTH
Overview
QUALITY IMPROVEMENT MANAGER role at BLEHEALTH. This position requires coordinating and leading performance improvement and risk management activities across the organization to ensure quality of care and regulatory compliance. Base pay range
$26.00/hr - $30.00/hr Responsibilities
Under the direction of the Clinical Director, Clinical Oversight Senior Manager, and Operations Director, provide administrative, technical, and coordinating support to and for the Performance Improvement Council (PIC) in the development, implementation and evaluation of the Performance Improvement Program that meets accreditation and regulatory guidelines. Be responsible for compliance, audit, and in charge of the QI Team. Manage and coordinate the Performance Improvement and Risk Management Programs throughout the organization. Develop and maintain a performance measurement work plan and reporting calendar to ensure timely data collection, aggregation, analysis, and reporting of established health plans reports and performance measures related to key operational and clinical processes and outcomes. Oversee the preparation and timely submission of mandatory reports to appropriate regulatory agencies. Work with the billing department to improve claims processes. Supervise and monitor office staff and oversee Teramind activities. Lead improvement teams through the Plan-Do-Study-Act cycle and report on outcomes. Develop and implement quality improvement programs, identify areas for improvement, set goals, and design and implement strategies to address them; track effectiveness and adjust as needed. Lead quality improvement teams and collaborate with cross-functional teams to achieve quality improvement goals. Ensure workflow processes, communicate quality initiatives and results to stakeholders, and develop quality metrics (KPIs). Identify root causes of problems and develop effective solutions; manage electronic storage of quality improvement reports for stakeholders. Ensure compliance with relevant regulations and standards; manage BleHealth compliance program and annual evaluation of the plan’s effectiveness. Focus on patient safety and outcomes; develop and maintain policies and procedures; oversee the organization\'s risk management program; annually evaluate the risk plan’s effectiveness. Develop and manage processes for internal incident reporting; investigate and evaluate claims; coordinate and maintain a comprehensive patient safety program with annual evaluations. Collaborate with executive staff to investigate clinical events and lead root cause analyses; promote a culture of continuous quality improvement. Conduct internal audits; coordinate management of customer service standards and communications with members and staff. Coordinate data interpretation for HEDIS and non-HEDIS data; oversee dissemination of reminder letters and contacts related to areas of specialty. Work with management to identify strategies for improving members\' health status; participate in program development, guidelines, and preventive health initiatives; work with network providers to implement improvements. Ensure policies and procedures reflect assigned standards andBleHealth\'s progress is documented; attend meetings; prepare reports and presentations; oversee internal policy development and compliance with HIPAA and confidentiality requirements. Provide care management services, engage members, coordinate care, and connect members with resources; perform other duties as requested. Qualifications
High level of knowledge related to Home Care, Home Health, Case Management, UDS, and HEDIS standards, CDPH and CMS standards and regulations. Four or more years of recent performance improvement, quality management, and risk management experience in an acute care setting. Excellent English written/verbal communication skills; computer skills with Microsoft Office at an intermediate level; intermediate to advanced Excel for data analysis. Ability to negotiate physical environments safely; ability to lift up to 35 pounds and assist with patient lifting; ability to translate and understand written and auditory communications. Demonstrates HIPAA confidentiality and BleHealth\'s privacy policies; adheres to BleHealth\'s mission, values and standards. Job Qualifications and Skills
Preferred Master’s degree in public health or Healthcare Administration; or Bachelor\'s degree with 2-3 years healthcare experience. Demonstrated leadership, excellent communication skills, and knowledge of quality improvement methodologies (e.g., Lean, Six Sigma). Experience in data analysis and reporting; ability to work independently and as part of a team; experience in healthcare settings. Seniority level
Entry level Employment type
Part-time Job function
Quality Assurance Industries
Hospitals and Health Care Referrals increase your chances of interviewing at BLEHEALTH by 2x
#J-18808-Ljbffr
QUALITY IMPROVEMENT MANAGER role at BLEHEALTH. This position requires coordinating and leading performance improvement and risk management activities across the organization to ensure quality of care and regulatory compliance. Base pay range
$26.00/hr - $30.00/hr Responsibilities
Under the direction of the Clinical Director, Clinical Oversight Senior Manager, and Operations Director, provide administrative, technical, and coordinating support to and for the Performance Improvement Council (PIC) in the development, implementation and evaluation of the Performance Improvement Program that meets accreditation and regulatory guidelines. Be responsible for compliance, audit, and in charge of the QI Team. Manage and coordinate the Performance Improvement and Risk Management Programs throughout the organization. Develop and maintain a performance measurement work plan and reporting calendar to ensure timely data collection, aggregation, analysis, and reporting of established health plans reports and performance measures related to key operational and clinical processes and outcomes. Oversee the preparation and timely submission of mandatory reports to appropriate regulatory agencies. Work with the billing department to improve claims processes. Supervise and monitor office staff and oversee Teramind activities. Lead improvement teams through the Plan-Do-Study-Act cycle and report on outcomes. Develop and implement quality improvement programs, identify areas for improvement, set goals, and design and implement strategies to address them; track effectiveness and adjust as needed. Lead quality improvement teams and collaborate with cross-functional teams to achieve quality improvement goals. Ensure workflow processes, communicate quality initiatives and results to stakeholders, and develop quality metrics (KPIs). Identify root causes of problems and develop effective solutions; manage electronic storage of quality improvement reports for stakeholders. Ensure compliance with relevant regulations and standards; manage BleHealth compliance program and annual evaluation of the plan’s effectiveness. Focus on patient safety and outcomes; develop and maintain policies and procedures; oversee the organization\'s risk management program; annually evaluate the risk plan’s effectiveness. Develop and manage processes for internal incident reporting; investigate and evaluate claims; coordinate and maintain a comprehensive patient safety program with annual evaluations. Collaborate with executive staff to investigate clinical events and lead root cause analyses; promote a culture of continuous quality improvement. Conduct internal audits; coordinate management of customer service standards and communications with members and staff. Coordinate data interpretation for HEDIS and non-HEDIS data; oversee dissemination of reminder letters and contacts related to areas of specialty. Work with management to identify strategies for improving members\' health status; participate in program development, guidelines, and preventive health initiatives; work with network providers to implement improvements. Ensure policies and procedures reflect assigned standards andBleHealth\'s progress is documented; attend meetings; prepare reports and presentations; oversee internal policy development and compliance with HIPAA and confidentiality requirements. Provide care management services, engage members, coordinate care, and connect members with resources; perform other duties as requested. Qualifications
High level of knowledge related to Home Care, Home Health, Case Management, UDS, and HEDIS standards, CDPH and CMS standards and regulations. Four or more years of recent performance improvement, quality management, and risk management experience in an acute care setting. Excellent English written/verbal communication skills; computer skills with Microsoft Office at an intermediate level; intermediate to advanced Excel for data analysis. Ability to negotiate physical environments safely; ability to lift up to 35 pounds and assist with patient lifting; ability to translate and understand written and auditory communications. Demonstrates HIPAA confidentiality and BleHealth\'s privacy policies; adheres to BleHealth\'s mission, values and standards. Job Qualifications and Skills
Preferred Master’s degree in public health or Healthcare Administration; or Bachelor\'s degree with 2-3 years healthcare experience. Demonstrated leadership, excellent communication skills, and knowledge of quality improvement methodologies (e.g., Lean, Six Sigma). Experience in data analysis and reporting; ability to work independently and as part of a team; experience in healthcare settings. Seniority level
Entry level Employment type
Part-time Job function
Quality Assurance Industries
Hospitals and Health Care Referrals increase your chances of interviewing at BLEHEALTH by 2x
#J-18808-Ljbffr