Job description

Director of Quality Management (RN) needed for a permanent opportunity with Yoh’s client located in French Camp, CA!

Top Skills Should You Possess:

• At least five (5) years of experience in Quality Management and/or Disease Management
• At least five (5) years of supervisory experience

What You’ll Be Doing:

• Supervise Quality staff, including management staff
• Develop operational objectives and plans; ensure the development and implementation of associated business plans and tactics to ensure compliance with relevant state and federal regulatory requirements for the Quality Program and NCQA accreditation requirements
• Anticipate the need for, and develop and implement relevant and effective quality management programs based on opportunities, issues and trends
• Anticipate, identify, analyze and report on quality opportunities, issues and trends; makes appropriate recommendations; develops and implements agreed upon changes
• Assist Chief Medical Officer and Associate Medical Director in identifying medical service issues that have an impact on plan benefits and their administration; assist subordinate managers in resolving medical claims review, grievances, appeals, quality and other medical management issues
• Collaborate with internal and external stakeholders to develop programs that increase awareness and provide educational opportunities to providers and members regarding the organization’s Quality Management program goals and activities
• Conduct or oversee the preparation, implementation and corrective action plans for internal and external audit activities to ensure practices adhere to Milliman guidelines, NCQA requirements, regulatory guidelines and organization’s criteria
• Develop and manage department budgets; implement appropriate interventions
• Lead and Oversight NCQA accreditation activities to ensure ongoing compliance
• Oversee the HEDIS process of monitoring, reporting and implementation of interventions for improvement
• Oversee the credentialing and peer review process
• Collaborate with medical management and other departments to ensure that the Quality program meets or exceeds NCQA and regulatory standards

What You Need to Bring to the Table:

• Active and unrestricted California RN license
• Bachelors Degree in Nursing, Business Management or related field required; Masters Degree in Nursing preferred
• At least five (5) years in Quality Management and/or Disease Management in a healthcare setting
• At least five (5) years supervisory experience in a healthcare setting; or equivalent combination of education and experience
• Experience in an HMO or managed care setting highly preferred
• Experience in Quality Management for government-sponsored programs highly preferred
• Experience in a managed care environment preferred
• Strong clinical skills
• Very strong knowledge of NCQA standards and their application to quality and disease management
• In-depth knowledge of and proficient skills in administering protocols for quality management
• In-depth knowledge of regulatory requirements pertaining to quality management and credentialing
• In-depth knowledge of standard contract components and contract language specific to healthcare
• Strong knowledge of medical management information systems and their interrelationships
• In-depth knowledge of audit, control and monitoring processes, and the ability to effectively implement and maintain them
• Financial acumen: interpret and apply understanding of key financial indicators to make better business decisions

What are you waiting for? Apply Now!

Recruiter: Jennifer Andersen

Yoh makes finding and applying for jobs simple. Partner with Yoh to find the right opportunities across multiple industries in the US and UK.

Note: Any pay ranges displayed are estimations. Actual pay is determined by an applicant's experience, technical expertise, and other qualifications as listed in the job description. All qualified applicants are welcome to apply.

Yoh, a Day & Zimmermann company, is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

Visit https://www.yoh.com/applicants-with-disabilities [1]to contact us if you are an individual with a disability and require accommodation in the application process.

Links:
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[1] https://www.yoh.com/applicants-with-disabilities
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