Quantum Health
  • Clinical Services
  • Columbus, OH, USA
  • Full Time
  • M-F Regular work schedule, 401K, Casual Culture

 

Job Title: Director,Clinical Quality Improvement

Working Group: Clinical Services

Reports to:  Vice President, Clinical Solutions

Purpose:  Develop, maintain, and evaluate tools, techniques and processes that assess the overall effectiveness and impact of Quantum Health's clinical programs

 

Duties and responsibilities:

  • Develop and implement a comprehensive quality improvement plan specific to clinical programs
  • Manage the identification, development and documentation for clinical quality improvement efforts that demonstrate compliance with the requirements of URAC and meet  other applicable regulatory requirements
  • Design and oversee the application of internal clinical audit and evaluation processes
  • Participate in the development of a clinical dashboard and associated data collection activities that report on the volume, work processes and impact of clinical activities
  • Develop, implement, analyze and recommend follow up actions for patient surveys to assess member satisfaction with clinical processes.
  • Support clinical leadership in the identification, design, analysis, evaluation and completion of efforts to address meaningful clinical process improvement opportunities.
  • Train and facilitate clinical work teams in process improvement efforts.
  • Responsible for the coordination and completion of clinical responses to  RFP requests, requests to review plan documents for recommended benefit language changes or enhancements that focus on clinical issues  and the maintenance of current applicable language and functional descriptions of clinical processes and content
    • Participate in the development, implementation, monitoring and maintenance of clinical policies/workflows or clinical topic policy or position papers
    • Develop and maintain currency in related healthcare clinical quality improvement efforts
    • Advise and educate clinical leadership on quality improvement topics, strategies and improvement efforts
    • Actively participate in clinical leadership meetings and activities
    • Attend Quality Work Team Meetings
      • Other duties as assigned

Skills and Qualifications:

  • Current unrestricted license as a Registered Nurse in the state of Ohio
  • Bachelor 's degree in nursing or a closely related field or equivalent experience
  • Minimum 3 years clinical experience
  • Minimum of 1 year of managerial or supervisory experience
  • Minimum of 2 years of health care quality improvement experience preferably in a managed care environment
  • Knowledge of quality improvement theory and methodologies including process improvement, study design, statistical methods, analyses, summary reports and the ability to apply these methods to varied activities
  • Experience with the verbiage, use and application of  health benefits management concepts including benefit design and plan language
  • Understanding of all aspects of Care Coordination practiced at Quantum Health, including administrative customer service (benefits, eligibility, claims) and Care Management (UM, CM and DM)
  • Possess excellent verbal, written and presentation skills
  • Ability to make timely and appropriate decisions and recommendations relative to QI efforts
  • Ability to work independently
  • Detail oriented
  • Possess excellent follow through and time management skills
  • Computer literate with the ability to use Microsoft office suite software
  • Able to function in team environment
  • Strong client relations and customer service skills
  • All job offers are contingent on successful completion of a background and reference check



This position has been closed and is no longer available.
Quantum Health

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