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Vice President Quality Management- Corporate Job
Amerigroup
Date: Jun 2, 2013
Location: Virginia Beach, VA, US
Vice President Quality Management- Corporate
Job ID 2010-12454 # Positions 1
Location US-VA-Virginia Beach
Search Category Quality
Type Regular Full-Time (30+ hours) Posted Date 1/13/2012
Additional Locations ..
More information about this job:
Summary:
Develops, coordinates and executes the clinical quality accreditation and compliance programs for all Health Plans. Drives selection of indicators for monitoring and evaluating quality and appropriateness of care/service; assessing for continuous improvement in all activities, drives member satisfaction, and evaluates the effectiveness of interventions across the continuum of care to members as it pertains to clinical quality programs. Provides operational leadership for companywide member/provider satisfaction surveying, appeals, complaints and grievances compliance, and NCQA accreditation.
Responsibilities:
1. Provides leadership for implementation of the comprehensive Clinical Quality Management Program.
2. Establishes corporate and health plan quality accreditation and compliance objectives and annual goals.
3. Promotes organization-wide understanding, communication, education and coordination of all programs, initiatives and activities related to NCQA accreditation and compliance.
4. Oversees the companywide Accreditation, Appeals and Satisfaction QM Scorecard reporting including analyzing validity of plan and corporate aggregate data/reports from a CQI perspective and develops action plans for improvement.
5. Provides leadership for the development, implementation, and evaluation of the Corporate Trilogy Documents: Provides guidance and consultation to corporate medical management departments regarding annual evaluations and impact on accreditation; defines and implements action plans towards improvement.
6. Oversees the Medicaid Adult and Child CAHPS Survey, the Medicare CAHPS and HOS Surveys and the Provider Satisfaction Survey across the company; provides plan/aggregate analysis and impact information, leads and guides the Member Experience and Provider Satisfaction Committees towards satisfaction excellence.
7. Oversees the Appeal, Complaint and Grievances and Delegation Oversight process for the organization; oversight of standardization of core policy, procedures, processes, tools and systems to manage these functions; conducts quarterly and annually reporting specific to turn around times, overtime rates and complaints/thousand.
8. Supports the health plans’ External Quality Review Organization (EQRO) state audit processes; maintains an inventory of all health plan EQRO audit dates, results and any CAP’s. Proactively reviews and monitors plans progress towards improvement as well as conducts pre-audit readiness reviews; provides reporting and analysis quarterly.
9. Oversees and provides leadership for the companywide Quality Improvement Council (QIC); responsible for the corporate trilogy documents; provides leadership and direction regarding corporate and health plan clinical governance as it relates to quality accreditation and compliance; incorporates Patient Safety Program as part of duties and responsibilities.
10. Assists the Senior Vice President with the annual operating and capital budget to sufficiently meet departmental needs and ensure the department stays within budget and accounts for variances for costs and employee management for assigned areas of accountability.
11. Responsible for department and company Quality Management orientation and education programs.
12. Interviews, manages, evaluates, and develops new and existing departmental staff.
13. Perform other duties as requested or assigned.
Qualifications:
EDUCATION AND EXPERIENCE
Education
Required:
- Bachelor’s Degree in related field or equivalent experience in lieu of degree.
Preferred:
- MSN or other Master’s Degree.
Years and Type of Experience Required:
Required:
- 10 years of relevant experience in quality management and/or utilization management in a managed care organization.
- 6 years of leadership/management experience Working knowledge of current managed care quality management principals and programs (i.e., Delegation Oversight, PIP, and Trilogy Documents).
- Familiarity/experience with NCQA & HEDIS programs.
Preferred:
- New market expansion experience.
Certifications or Licensures
Required:
- N/A
Preferred:
- Registered nurse with current license desirable.
Language Skills
Required:
- English
Preferred:
- N/A
Functional Competencies
- Proficient in the use of Microsoft Office products, to include Outlook, Word, Excel and PowerPoint.
- Excellent program management skills, with the capability to effectively manage program and processes across multiple areas of the organization.
SCOPE INFORMATION
# Direct Reports: 4-10
# Indirect Reports: varies
Budgetary $ Responsibility: varies
PHYSICAL REQUIREMENTS
The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Must be able to operate general office equipment including but not limited to: computer, phones and related media and information devices.
- Ability to communicate both in person and/or by telephone.
- Must be able to travel as needed and adhere to Amerigroup travel policies and procedures.
CB1
ermHO
Job ID 2010-12454 # Positions 1
Location US-VA-Virginia Beach
Search Category Quality
Type Regular Full-Time (30+ hours) Posted Date 1/13/2012
Additional Locations ..
More information about this job:
Summary:
Develops, coordinates and executes the clinical quality accreditation and compliance programs for all Health Plans. Drives selection of indicators for monitoring and evaluating quality and appropriateness of care/service; assessing for continuous improvement in all activities, drives member satisfaction, and evaluates the effectiveness of interventions across the continuum of care to members as it pertains to clinical quality programs. Provides operational leadership for companywide member/provider satisfaction surveying, appeals, complaints and grievances compliance, and NCQA accreditation.
Responsibilities:
1. Provides leadership for implementation of the comprehensive Clinical Quality Management Program.
2. Establishes corporate and health plan quality accreditation and compliance objectives and annual goals.
3. Promotes organization-wide understanding, communication, education and coordination of all programs, initiatives and activities related to NCQA accreditation and compliance.
4. Oversees the companywide Accreditation, Appeals and Satisfaction QM Scorecard reporting including analyzing validity of plan and corporate aggregate data/reports from a CQI perspective and develops action plans for improvement.
5. Provides leadership for the development, implementation, and evaluation of the Corporate Trilogy Documents: Provides guidance and consultation to corporate medical management departments regarding annual evaluations and impact on accreditation; defines and implements action plans towards improvement.
6. Oversees the Medicaid Adult and Child CAHPS Survey, the Medicare CAHPS and HOS Surveys and the Provider Satisfaction Survey across the company; provides plan/aggregate analysis and impact information, leads and guides the Member Experience and Provider Satisfaction Committees towards satisfaction excellence.
7. Oversees the Appeal, Complaint and Grievances and Delegation Oversight process for the organization; oversight of standardization of core policy, procedures, processes, tools and systems to manage these functions; conducts quarterly and annually reporting specific to turn around times, overtime rates and complaints/thousand.
8. Supports the health plans’ External Quality Review Organization (EQRO) state audit processes; maintains an inventory of all health plan EQRO audit dates, results and any CAP’s. Proactively reviews and monitors plans progress towards improvement as well as conducts pre-audit readiness reviews; provides reporting and analysis quarterly.
9. Oversees and provides leadership for the companywide Quality Improvement Council (QIC); responsible for the corporate trilogy documents; provides leadership and direction regarding corporate and health plan clinical governance as it relates to quality accreditation and compliance; incorporates Patient Safety Program as part of duties and responsibilities.
10. Assists the Senior Vice President with the annual operating and capital budget to sufficiently meet departmental needs and ensure the department stays within budget and accounts for variances for costs and employee management for assigned areas of accountability.
11. Responsible for department and company Quality Management orientation and education programs.
12. Interviews, manages, evaluates, and develops new and existing departmental staff.
13. Perform other duties as requested or assigned.
Qualifications:
EDUCATION AND EXPERIENCE
Education
Required:
- Bachelor’s Degree in related field or equivalent experience in lieu of degree.
Preferred:
- MSN or other Master’s Degree.
Years and Type of Experience Required:
Required:
- 10 years of relevant experience in quality management and/or utilization management in a managed care organization.
- 6 years of leadership/management experience Working knowledge of current managed care quality management principals and programs (i.e., Delegation Oversight, PIP, and Trilogy Documents).
- Familiarity/experience with NCQA & HEDIS programs.
Preferred:
- New market expansion experience.
Certifications or Licensures
Required:
- N/A
Preferred:
- Registered nurse with current license desirable.
Language Skills
Required:
- English
Preferred:
- N/A
Functional Competencies
- Proficient in the use of Microsoft Office products, to include Outlook, Word, Excel and PowerPoint.
- Excellent program management skills, with the capability to effectively manage program and processes across multiple areas of the organization.
SCOPE INFORMATION
# Direct Reports: 4-10
# Indirect Reports: varies
Budgetary $ Responsibility: varies
PHYSICAL REQUIREMENTS
The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Must be able to operate general office equipment including but not limited to: computer, phones and related media and information devices.
- Ability to communicate both in person and/or by telephone.
- Must be able to travel as needed and adhere to Amerigroup travel policies and procedures.
CB1
ermHO
Nearest Major Market: Virginia Beach
Job Segments: Quality, Manager, Quality Manager, Program Manager, Executive, Management