Manager Health Care, Quality Project Management

Job DescriptionThe Manager Health Care, Quality Project Management leads cross-functional activities throughout the health plan to address CAHPs and BH survey responses and ensure effective implementation of these activities to gain positive outcomes. This person will facilitate collaborative partnerships with different departments to meet NCQA standards while monitoring for state requirements as they align with Health Plan goals of maintaining and sustaining accreditation status, as well as looking to advance the Health Plan for other accreditation opportunities. In addition, this person will have knowledge of how population health is integrated throughout the plan and will support program creation. Most importantly, the role will involve a thorough knowledge of how to write and develop a QAPI workplan, QAPI program description and evaluation while working with the QM director in managing expectations from the different areas to fulfill these requirements. Accountable for NCQA and state projects and initiatives through direction setting and leadership Develops readiness assessment schedules, conducts in house audits regularly, and ensures changes to the standards are incorporated Collaborates with business leads to identify variances and areas for improvements and implements project plans to ensure resolution and compliance to NCQA standards Schedules and conducts NCQA work group meetings to produce and develop the QAPI work plan, evaluation and programs Facilitate ongoing annual qualitative and quantitative analyses, assuring business owners are taking action on their opportunities for improvement Quality Improvement Projects Assists in quality improvement initiatives related to accreditation, including but not, limited to the engineering of operational processes to improve efficiencies and achieve continuous quality improvement Trains and onboards staff and business leads on NCQA standards, and ongoing to ensure their continuing understanding of requirements Manages CAHPS and provider satisfaction surveys Creates and identifies work groups to address and develop action items based on CAHPS, Behavioral Health satisfaction surveys and provider satisfaction results including monitoring of implementation of actionable items within the plan Coordinates QMOC, QMC and UMC Oversees maintenance of MHC distinction award and/or other accreditations Performs regular audits of website, member handbooks, provider manuals and newsletters for NCQA complianceRequired Qualifications 3 years experience in a project management role. 3 years experience working in the Health Care Insurance Industry. Must have full understanding of NCQA standards Must be proficient in all Microsoft office Suite, especially Microsoft Excel. Must be analytical and able to interpret data Must be articulate and able to communicate to multiple internal and external stakeholders. Must have experience in leading an organization through accreditation Must be a proficient writer an possess an innate ability to communicate effectively written and orally.COVID RequirementsCOVID-19 Vaccination RequirementCVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated. You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.Preferred Qualifications 3 years knowledge and experience with Medicaid.EducationBachelors Degree or equivalent work experience.Business OverviewBring your heart to CVS HealthEvery one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at its center - our purpose sends a personal message that how we deliver our services is just as important as what we deliver.Our Heart At Work Behaviors support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.

Created: 2024-10-19