New Directions Behavioral Health Manager, Quality Management in Kansas City, Missouri
The Manager, Quality Management supports the Corporate Vice President of QM&A through management of business and clinical processes subject to NCQA and URAC standards, HEDIS monitors, customer delegation requirements and applicable Federal and State regulatory requirements. The Manager provides direction, assistance and oversight of Regional Service Center (RSC) QI staff (direct reports). Accurate and professional reporting of clinical and service processes, goals, outcomes, safety management, satisfaction, risk management and quality of care improvement studies is the responsibility of the Manager of QM. The Manager will also identify gaps in performance for accreditation and operational performance and facilitate improvement workgroups, teams or committees for performance improvement.
• Responsible for maintaining compliance with policies and procedures, as well as, accreditation, regulatory and customer requirements for the day-to-day operations. To facilitate accomplishment of goals, management of these operations includes, but is not limited to, coordination and interface with Clinical & Service operations, Compliance, Account Management, Network Operations, IT, Data Analytics, Communications and Health Plan customers.
• Maintains oversight of the RSC QM Committee and Sub-Committee operations including committee scheduling, work plans, production of contemporaneous committee minutes, reporting and processes in support of the QM program, accreditations and compliance. Responsible for presentations to the Corporate QM Committee.
• Chair of the Regional Quality Management Committee and manages the Provider Advisory Committee as a member.
• Ensures that monthly/quarterly reports in the department are timely, inclusive of appropriate analysis, root cause analyses and interventions (when applicable) and show evidence of ongoing monitoring.
• Supports the Vice President, QM&A in facilitating the completion of New Directions annual QM Program Description, Work Plan, mid-year Work Plan Updates and the Annual QM Program Evaluations for designated RSC customers.
• Maintains current knowledge of compliance with policy, procedure and regulatory requirements in the organization and in the department.
• The Manager, QM will be responsible for the oversight of complaints and clinical incidents.
• Solves complex problems and/or conducts complex analyses Works with minimal guidance; seeks guidance on the most complex tasks
• Responsible for direct personnel management of department staff including supervising, coaching, conducting performance assessments and allocating staff to projects and required reporting. Provides consultation and guidance to others within the organization.
• Coordinate and monitor activities among internal departments, external community agencies including DHS, Medicare and the DOH programs excluded from QUEST integration, as well as HMSA partners/vendors.
• Exhibit cultural sensitivity to people of various ethnic origins and socioeconomic backgrounds.
• Requires safely operating an insured automobile for travel to off-site locations to conduct and accomplish business related activities.
• Must have valid driver’s license, access to an automobile with current license, registration and no fault insurance.
• Must be willing to travel to neighbor islands and/or work occasional evenings and weekend hours/days.
• Adheres to New Directions Behavioral Health Mission Statement, Core Values, Code of Business Conduct, and Compliance Program.
• Complies with all Federal and applicable State laws and New Directions Behavioral Health Policies regarding, privacy, confidentiality, and security of health information, and other designated information
EDUCATION & EXPERIENCE REQUIRED
• Bachelor’s Degree or a combination of education and experience commensurate for the role
• 3+ years of management experience with direct reports
• 4 or more years of experience in a health care Quality Improvement/Management department
• 2 or more years of direct experience with accreditations (hospital, facility or managed care)
• Working knowledge of performance improvement processes and team processes/collaborative team management
• Understanding of business processes
• Understanding of risk issues and sentinel event processes/management
• Adept with Microsoft Office (primarily Word, Excel, PowerPoint and Outlook) and willing to learn other software applications
• CPHQ certification; LEAN Six Sigma certification or other related certification; or willing to acquire within a year of hire. (experience may be considered as a temporary substitute)
• Travel – 10-20% (assumes located at corporate office)
- Prefer location in Kansas City office, open to remote location for right candidate
• Master’s Degree
• 3 or more years of experience in a managed care organization
• Licensed registered nurse with behavioral health experience or Licensed behavioral health clinician
• Current or past employment in a behavioral healthcare environment
• 2 or more years of experience addressing member complaints, internal concerns and/or incident reports
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information.