The QI Project Manager supports the development and implementation of quality improvement interventions and audits and assists in resolving deficiencies that impact plan adherence to regulatory and accreditation standards. The Project Manager will also assist in driving key quality improvement projects requiring the ability to work effectively in a matrix environment.
Establishes and/or revises existing company policies and procedures necessary for successful implementation of the Quality Improvement (QI) Program.
Works with SWH’s QI team members to convene various QI committees and work groups, set agenda to drive desired meeting outcomes (based on contract and accreditation requirements), and ensure proper recording of committee activities.
Acts as knowledge expert for continuous quality improvement activities, educating staff of other functional areas regarding the QI process and accreditation requirements.
Monitors clinical quality studies to include receipt and analysis of trended data, assessment of national benchmarks as available, and the development of improvement recommendations
Recommends strategies to improve member compliance with QI program activities including community outreach, training and communication.
Assists in fielding annual member Care Management (CM), Disease Management (DM), and Complex Care Management (CCM) satisfaction surveys, working to clarify results and develop recommendations based upon analysis of findings.
Assists with efforts to secure or maintain successful NCQA accreditation.
Assists in conducting corporate trainings on NCQA accreditation and supports department leads in completing required NCQA documentation and collateral materials.
Participates in site visit preparation and execution by various regulatory and accreditation agencies (ex. NCQA, MassHealth, CMS).
Monitors and tracks all NCQA reporting requirements and preps materials for posting to NCQA ISS Tool. Works with IT to ensure needed project management support.
Supports efforts to submit required regulatory performance reports as dictated by the contracts (ex. CCIP, QCP).
Assists in developing short range plans for overall quality improvement program activities. Refreshes the project schedule as needed to accomplish the accreditation and regulatory reporting activities.
Acts in liaison capacity with other areas and business units regarding QI processes and timelines.
Makes recommendations on matters of policy and supports department heads in creation, or revision of needed policies, notifications, reports or analysis.
Supports the documentation and organization of all QI Program materials, committee minutes, special projects according to the corporate standard.
Maintains and updates all QI Program documents.
Participates at the QI Program Committees.
Performs other duties as assigned.
Bachelor's Degree in a related health field.
At least 5 years of experience in a health care delivery organization, such as a managed care organization or a hospital environment.
At least 3 years of process improvement and project management experience.
Basic knowledge of Medicaid and/or Medicare programs.
Basic knowledge of current trends in quality and utilization improvement in managed health care.
Ability and willingness to learn from technical manuals and communications regarding Government (CMS and State Medicaid) and accrediting entity requirement.
Proficient in Microsoft Excel, Word, Visio, PowerPoint and Outlook.
Position can be located in Bridgewater MA or Cambridge MA. This is an office based position with minimal travel to other SWH locations.
Senior Whole Health - 2 years ago