Manager, Clinical Quality

About the role

Responsible for leading and directing a team of clinical and non-clinical staff that provide Clinical Quality Review services and interventions for beneficiaries and providers under the direction of the Director of Clinical Quality Management (CQM).

Works to develop and implement clinical program components to optimize safety and quality strategies, goals, policies and procedures to ensure compliance with contract and accreditation standards.

Responsibilities

• Direct operational leadership of CQM functions and staff to ensure compliance with contract requirements and adherence to contract deliverables.
• Plans, organizes, and implements collection of data and preparation of reports that support CQM management activities.
• Systematically evaluates the quality and effectiveness of staff performance, analyzing appropriate data and information to identify areas of improvement; advises and coaches when appropriate and completes annual performance appraisals.
• Participates in the development of measurable outcomes, ensures measures are in place to monitor the impact of programs and services on the health status of beneficiaries being managed.
• Plans and implements orientation and training strategies for new-hire employees.
• Develops and maintains expertise in contract and accreditation requirements as they pertain to CQM.
• Ensures adherence to accreditation standards, TRICARE policy, contractual requirements, and nationally recognized practice standards.
• Participates in development and annual review of desk procedures, education and auditing to support uniform application of programs and compliance with program policy and standards.
• Serves as the primary point of contact for the CM committees.
• Maintains the confidentiality and non-discoverability of all quality issues.
• Ensures appropriate documentation, implementation, and evaluation for corrective actions on defined quality issues are maintained.
• Supervises staff to include interviewing and hiring; planning and implementing orientation and training strategies for new-hire employees; setting and managing expectations, coaching and ensuring team and individual goals are met.
• Aids staff in identifying, developing, and monitoring progress of quality studies and conducting focused reviews.
• Aids staff in timely, concise, and accurate data collection, analysis and reporting of quality issues (verbal and written).

Requirements

• Bachelor’s degree in Nursing, Health Administration, health-related field or equivalent education and experience.
• Registered Nurse with current unrestricted license.
• U.S. Citizen.
• Must be able to receive a favorable Interim and adjudicated final Department of Defense (DoD) background investigation.
• 5 years’ clinical experience in Medical Surgical and Behavioral Health.
• 3 years’ direct experience in Quality Management and Quality Studies.
• 3 years’ supervisory experience.

Qualifications

• Master’s Degree in Nursing or another health-related field.
• Certified Professional in Healthcare Quality (CPHQ).
• Experience analyzing large data sets.
• Experience writing professional reports.
• Experience conducting medical records abstracting and quality investigations.
• Knowledge of TRICARE, Medicare, or government health care programs.

Skills

• Coaching / Training / Mentoring.
• Communication / People Skills.
• Computer Literacy.
• Delegation Skills.
• High Intensity Environment.
• Leadership.
• Multi-Tasking / Time Management.
• Problem Solving / Analysis.
• Team-Building / Team Player.
• Technical Skills.

Benefits

Includes Medical, Dental and Vision Coverage, Paid time off, 401(k) Retirement Savings Plan (with matching), Short-term and long-term disability, basic life, and accidental death and dismemberment insurance, Tuition reimbursement, and Paid volunteer time.

Salary Range: $108,000 - $120,000 per year.

Equal Employment Opportunity: TriWest Healthcare Alliance is an equal employment opportunity employer. We are proud to have an inclusive work environment and know that a diverse team is a strength that will drive our success.