Quality Program Manager for AllCareHealth Headquarters in Grants Pass, Oregon
We Are Seeking A Qualified Candidate to Join Our Team!
Summary
The Quality Manager supports the implementation and ongoing operations of the Quality Program for AllCare Health Plan, Inc and CCO. This role is responsible for coordinating day-to-day quality activities, including the collection, management, and preliminary analysis of quality data, and assisting in the preparation of reports to support organizational quality initiatives.
The Quality Manager applies knowledge of Continuous Quality Improvement (CQI) methodologies and supports Performance Improvement Projects (PIPs), and quality measurement activities including HEDIS ®; CAHPS ®; HOS ®; HOS-M®; Medicaid Quality Measures; and Star Ratings ®. This role works under the direction of the Quality Director to ensure quality program activities are executed effectively and in alignment with regulatory requirements.
Essential Duties
* Supports the implementation and tracking of quality measures and initiatives.
* Coordinates logistics and documentation for Quality Improvement (QI) Committee meetings, including agenda preparation and note-taking.
* Assists in the preparation and validation of quality reports in collaboration with internal IT partners.
* Coordinates with internal departments to support Quality Improvement Program activities.
* Tracks and monitors quality data and escalate issues or trends to the Quality Director.
* Maintains working knowledge of requirements from Centers for Medicare and Medicaid Services and the Oregon Health Authority and applies them to assigned tasks.
Job Duties
* Participate in meetings as they relate to QI program;
* Coordinates and supports the implementation of quality programs and initiatives, including: HEDIS ®, CAHPS ®, HOS ® and HOS-M®, ensuring activities are carried out in alignment with established plans and timelines
* Assist in the development, documentation, and execution of the Quality Assessment and Performance Improvement program (QAPI), Performance Improvement Projects (PIPs), Quality Improvement Projects (QIPs), Chronic Condition Improvement Projects (CCIP), and other quality improvement initiatives;
* Compiles, analyzes, and maintains quality data and reports; collaborates with Information Systems staff to support data validation, reporting processes, and submission of materials to internal committees;
* Coordinates quality management activities, including medical record review processes, quality audits, and support for committee and workgroup operations;
* Supports the review and maintenance of quality-related policies and procedures by assisting with updates, documentation, and implementation of established processes;
* Works cross-functionally with internal teams and providers to support adherence to quality standards, escalate issues, and facilitate improvement efforts;
* Provides operational support and technical assistance to staff and subcontractors related to quality tools, reporting requirements, and program activities;
* Assists in preparing required quality improvement materials and documentation for submission to regulatory and oversight entities, including the Oregon Health Authority and Centers for Medicare and Medicaid Services;
* Maintains punctual, regular and predictable attendance;
* Works collaboratively in a team environment with a spirit of cooperation;
* Respectfully takes direction from the Chief Medical Officer and Director of Quality;
* Meets all required training including those listed in Relias Learning Module System (LMS);
* Other duties as assigned.
On Call Responsibilities
This position does not have any on call responsibilities.
Supervisory Responsibilities
This position does have supervisory responsibilities.
The Quality Manager directly supervises four employees in the Quality department. The Quality Manager provides day-to-day oversight of assigned quality staff in accordance with the organization’s policies and applicable laws. Responsibilities include supporting onboarding and training, assigning and monitoring work, providing input into performance evaluations, and addressing routine staff questions and issues. Escalates employee relations matters, including disciplinary actions and complex concerns, to the Quality Director.
Job Requirements
* May require a flexible schedule, hours may vary depending on work locations, meeting sites, and educational development opportunities.
* May require the use of personal vehicle for local travel (subject to mileage reimbursement).
* May require the use of a personal cell phone (cell phone stipend available)
Qualifications
Ability to perform essential job duties with or without reasonable accommodation and without posing a direct threat to safety or health of employee or others. To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential duties.
Nursing degree or Master’s in Public Health preferred but individuals with experience in leading a quality improvement program may be considered. Experience working with disadvantaged populations and knowledge of health disparities are highly desired.
Education
Bachelor's degree (B. A.) from four-year college or university; or one to two years related experience and/or training; or equivalent combination of education and experience.
Nursing degree or Master’s in Public Health, preferred.
Experience
* Two to four years related experience and/or training in healthcare quality improvement, quality management, or related field.
* Experience supporting quality programs within a managed care organization, Coordinated Care Organization (CCO), health plan, or healthcare delivery system.
* Experience working with disadvantaged populations and knowledge of health disparities are highly desired.
* Demonstrated experience working with quality metrics and reporting, including HEDIS ®, CAHPS ®, HOS ® and HOS-M®.
* Experience working with healthcare data, including data collection, validation, analysis, and reporting.
* Experience coordinating PIPs or other quality improvement initiatives.
* Prior experience providing day-to-day guidance or oversight to staff or project teams, preferred.
Certificates, Licenses and/or Registrations
* Valid Oregon Driver’s License and vehicle insurance, required.
* Certified in Quality or Quality Management, preferred.
* Registered Nurse License, preferred.
Technical Skills
* Proficiency in Microsoft Office Suite (Excel, Word, Outlook, Teams, SharePoint).
* Experience with healthcare quality data tracking systems and documentation management.
* Ability to prepare clear, accurate reports and presentations.
* Knowledge of quality improvement methodologies and tools, such as PDSA cycles, root cause analysis, and process mapping.
Interpersonal Skills
* Inclusive leadership and management: Bring a clear vision and recognize the value of divergent perspectives. Approaches leadership with mindset of “power with” rather than “power over” and regularly includes others in planning and decision-making. Able to make and communicate difficult decisions in the best interest of AllCare.
* Attentive, empathetic leadership: Enthusiasm for meeting and engaging with people. Able to put people at ease, especially when there are lines of difference. Listens closely to understand needs or concerns and takes steps based on that input. Gets back to people in a timely manner. Takes pride in providing clear, helpful information.
* Proactive problem solving: Proactively develop solutions to challenges, including by constantly looking at big-picture progress and thinking about people.
* Flexibility: Ready to take advantage of unexpected opportunities; adapts quickly to change and is a teacher to assist with change within the organization. Commitment to solving unresolved issues in an effort to collaborate and model problem solving.
* Equitable Practices translates into plans for staff development, retention, strategy, and improving culture.
Language Skills
Ability to interpret and apply complex regulatory guidance, prepare clear and accurate reports, and communicate technical information to diverse audiences. Skilled at documenting processes and findings, reviewing materials for accuracy and compliance, and facilitating meetings or presenting updates on quality initiatives.
Mathematical Skills
Ability to analyze, interpret, and summarize quantitative data, including quality metrics and performance measures. Skilled in performing basic statistical calculations, identifying trends, and preparing data-driven reports to support quality improvement initiatives and regulatory compliance. Proficient in using spreadsheets, data visualization tools, and reporting software to organize, validate, and present data accurately.
Computer Skills
Proficient in Microsoft Office Suite (Excel, Word, PowerPoint) and experience with data analysis, reporting, and visualization tools. Skilled in using healthcare data systems, electronic health records (EHRs), and quality or compliance tracking software to manage, validate, and present information accurately.
Reasoning Ability
Ability to analyze and interpret complex data, identify trends and issues, and apply logical thinking to support quality improvement initiatives. Skilled at making sound, evidence-based recommendations, solving operational problems, and escalating issues appropriately within organizational and regulatory frameworks.
Physical Demands & Work Environment
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential duties of this job. The work environment characteristics described here are representative of those an employee encounters while performing the essential duties of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential duties.
The employee must occasionally lift and/or move up to 10 pounds. While performing the duties of this job, the employee is regularly required to sit; use hands to finger, handle, or feel and talk or hear. The employee is occasionally required to stand; walk and reach with hands and arms. The noise level in the work environment is usually moderate.
* The employee must be able to work onsite, as needed.
* The employee is eligible to work from a home office, occasionally.
* The employee must be able to travel locally, as needed.
8:00-5:00PM with a 1 hour lunch and two 15 minute paid breaks
40 hours