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Registered Nurse (RN) - Manager
SSM Health
Madison, WI
$24-38/hourOverview
- Start DateASAP
Pay
Description
PRIMARY RESPONSIBILITIES
- Manage the planning, development, implementation, tracking, and evaluation of health plans' Quality Improvement initiatives, including (but not limited to) interventions that contribute to increasing member and provider compliance with HEDIS measures.
- Lead the collaborative development of quality improvement strategies to ensure members receive exceptional clinical care and an outstanding member experience as measured, in part, by HEDIS, CAHPS and the Health Outcomes Survey (HOS).
- Build and strengthen provider partner relationships and promote engagement in QI strategies.
- Develop and implement regulatory quality programming, including those required by the Centers for Medicare and Medicaid Services (CMS) for Qualified Health Plans on the Marketplace and Medicare Advantage Plans, ensuring timely and valid reporting to regulators
- Maintains working knowledge of HEDIS, CAHPS, and applicable NCQA accreditation standards to innovate and share best practices for improving health plan processes and performance to stakeholders across the organization and network
- Analyze quality performance and prepare written reports with quantitative and qualitative analysis, identify barriers, opportunities for improvement, and recommendations.
- Actively collaborate with Quality Managers to meet the business requirements of the QI Department.
- Coach, mentor, and develop the Quality Improvement staff in the areas of project design and management, performance measurement and process improvement.
- Promotes timely and effective communication based on individual and/or situational requirements and utilizes appropriate means to ensure adequate information flow.
- Assist in driving a culture of quality and process improvement throughout the organization.
- Performs other duties as assigned.
EDUCATION
Bachelor’s degree in healthcare administration, nursing or business
EXPERIENCE
Three years’ experience in managed care and/or healthcare quality management
Do you have a passion for ensuring high quality care? Are you a leader with 3 years experience in Healthcare Quality Measurement and/or Managed Care and looking to grow with an Exceptional Organization? At Dean Health Plan (DHP), we are focused on providing superior care and service to our members. DHP is seeking a motivated and experienced Quality and Performance Improvement Manager interested in designing systems, processes, and interventions to ensure exceptional patient care and to shape member experiences. Superior collaboration with clinics and physicians required. Preferred NCQA, HEDIS, CAHPS or RN experience.
Responsible for the development, coordination, implementation, and monitoring of all quality improvement initiatives related to HEDIS, CAHPS, and quality improvement projects. Responsible for bringing together multiple departments within to engage and enlist their input, recommendations and actions on interventions geared towards improving scores and quality improvement projects. Provides technical expertise in pay-for-performance and quality improvement strategies and methodologies. Participates in evaluating quality improvement programs endorsed by regional and national entities and provides recommendations to senior leadership staff regarding quality improvement program development. Creates an environment for continuous improvement and encourages others to strive for excellence.Employer
SSM Health
Madison, WI
About
Madison is the capital of Wisconsin, located about an hour west of Milwaukee. Frequently listed as one of the best places to live in the United States, this city ranks high in economy, diversity and education. Madison is a young and vibrant Midwestern town and is the home of the University of Wisconsin Madison, a top-ranked public institution. Visitors can’t miss the iconic Wisconsin State Capitol Building, a beautiful historic building located on a strip of land between Lakes Mendota and Monona, or the Olbrich Botanical Gardens, open year-round and boasting over 16 gardens. To really get a feel for this lively city, take a stroll down State Street, with seven blocks of bustling restaurants, beach access and street art.
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