Astiva Health, Inc
Manager of Quality Improvement
Base pay range:
$95,000 – $105,000 per year
Company:
Astiva Health, Inc., Orange, CA
About Astiva Health:
Astiva Health is a premier healthcare provider specializing in Medicare and HMO services. We prioritize accessibility, affordability, and quality care for our diverse community.
Summary The Manager of Quality Improvement oversees medical management functions including Quality Management, Quality Improvement (QI), Risk Adjustment Factors, and Quality Assurance. This key leader advances assigned areas toward enhanced capabilities and operational efficiency in alignment with Astiva’s strategic plan.
Essential Duties and Responsibilities
Develop strategy, deploy systems, refine workflows, and achieve metrics related to Quality Management, QI, and Quality Assurance.
Maintain compliance with operational procedures and reporting standards to meet state and federal requirements.
Collaborate with senior management to establish a strategic vision for STARS improvement aligned with Astiva’s business planning process.
Formulate strategies and execute tactical plans to enhance HEDIS, CAHPS, HOS, and other STARS-related measures.
Design and supervise monitoring and reporting protocols to keep deliverables and budgets aligned with expectations.
Annually review and update the QI program, evaluating effectiveness, updating work plans, and revising Medicare policies and procedures.
Develop quarterly processes for reporting on QI activity progress.
Oversee the operations of the health plan's credentialing program.
Ensure adherence to all relevant federal, state, and local laws and regulations.
Partner with internal departments to uphold compliance with the QI program and its policies.
Prepare reports and facilitate discussion and action by the Utilization Management/Quality Assurance Committee and during Board of Directors Meetings.
Collect, organize, examine, and present data regarding risk adjustment factors (RAF).
Conduct comprehensive concurrent and retrospective reviews promptly.
Develop and apply strategies to strengthen risk adjustment processes for accurate and thorough data collection.
Perform audits focused on the precision and completeness of risk adjustment documentation.
Recruit and retain skilled staff members to execute strategic and operational objectives, managing succession planning and leadership development.
Maintain regular communication with providers, members, employees, auditors, and regulators as needed.
Ensure regular and consistent attendance.
Other duties as assigned.
Education and Experience
7+ years senior-level Managed Care operations experience required.
Master’s in Public Health, Health Science, or RN/NP/BSN licensure.
5+ years QI experience at the plan level preferred.
Proven ability to build health plan QI programs.
Must be able to travel for work up to 5% of the time.
Experience with HMO, Medi-Cal/Medicaid, Medicare, insurance, or relevant government/public service preferred.
Board reporting and strategic planning experience preferred.
Experience overseeing delegated medical groups, IPAs, and contracted healthcare entities.
Other Skills and Abilities
Conduct analysis and revise policies across all business lines for Quality and Population Health Management Programs.
Demonstrate comprehensive expertise in HEDIS, STARS, RAF, HCC, and additional related quality and clinical care measures.
Possess thorough knowledge of core functions within the health plan environment and effectively address associated challenges.
Grasp primary objectives and systematically deconstruct them into actionable steps.
Display exemplary leadership qualities to guide and influence teams.
Apply advanced problem‑solving, analytical, and organizational skills with careful diligence.
Communicate effectively and professionally in both verbal and written formats.
Benefits
401(k)
Health insurance
Life insurance
Vision insurance
Paid time off
Employment Details Seniority level:
Mid‑Senior level
Employment type:
Full‑time
Job function:
Other
Industry:
Hospitals and Health Care
Location:
Orange, CA
#J-18808-Ljbffr
$95,000 – $105,000 per year
Company:
Astiva Health, Inc., Orange, CA
About Astiva Health:
Astiva Health is a premier healthcare provider specializing in Medicare and HMO services. We prioritize accessibility, affordability, and quality care for our diverse community.
Summary The Manager of Quality Improvement oversees medical management functions including Quality Management, Quality Improvement (QI), Risk Adjustment Factors, and Quality Assurance. This key leader advances assigned areas toward enhanced capabilities and operational efficiency in alignment with Astiva’s strategic plan.
Essential Duties and Responsibilities
Develop strategy, deploy systems, refine workflows, and achieve metrics related to Quality Management, QI, and Quality Assurance.
Maintain compliance with operational procedures and reporting standards to meet state and federal requirements.
Collaborate with senior management to establish a strategic vision for STARS improvement aligned with Astiva’s business planning process.
Formulate strategies and execute tactical plans to enhance HEDIS, CAHPS, HOS, and other STARS-related measures.
Design and supervise monitoring and reporting protocols to keep deliverables and budgets aligned with expectations.
Annually review and update the QI program, evaluating effectiveness, updating work plans, and revising Medicare policies and procedures.
Develop quarterly processes for reporting on QI activity progress.
Oversee the operations of the health plan's credentialing program.
Ensure adherence to all relevant federal, state, and local laws and regulations.
Partner with internal departments to uphold compliance with the QI program and its policies.
Prepare reports and facilitate discussion and action by the Utilization Management/Quality Assurance Committee and during Board of Directors Meetings.
Collect, organize, examine, and present data regarding risk adjustment factors (RAF).
Conduct comprehensive concurrent and retrospective reviews promptly.
Develop and apply strategies to strengthen risk adjustment processes for accurate and thorough data collection.
Perform audits focused on the precision and completeness of risk adjustment documentation.
Recruit and retain skilled staff members to execute strategic and operational objectives, managing succession planning and leadership development.
Maintain regular communication with providers, members, employees, auditors, and regulators as needed.
Ensure regular and consistent attendance.
Other duties as assigned.
Education and Experience
7+ years senior-level Managed Care operations experience required.
Master’s in Public Health, Health Science, or RN/NP/BSN licensure.
5+ years QI experience at the plan level preferred.
Proven ability to build health plan QI programs.
Must be able to travel for work up to 5% of the time.
Experience with HMO, Medi-Cal/Medicaid, Medicare, insurance, or relevant government/public service preferred.
Board reporting and strategic planning experience preferred.
Experience overseeing delegated medical groups, IPAs, and contracted healthcare entities.
Other Skills and Abilities
Conduct analysis and revise policies across all business lines for Quality and Population Health Management Programs.
Demonstrate comprehensive expertise in HEDIS, STARS, RAF, HCC, and additional related quality and clinical care measures.
Possess thorough knowledge of core functions within the health plan environment and effectively address associated challenges.
Grasp primary objectives and systematically deconstruct them into actionable steps.
Display exemplary leadership qualities to guide and influence teams.
Apply advanced problem‑solving, analytical, and organizational skills with careful diligence.
Communicate effectively and professionally in both verbal and written formats.
Benefits
401(k)
Health insurance
Life insurance
Vision insurance
Paid time off
Employment Details Seniority level:
Mid‑Senior level
Employment type:
Full‑time
Job function:
Other
Industry:
Hospitals and Health Care
Location:
Orange, CA
#J-18808-Ljbffr