Description
QUALIFICATIONS:
M.D. or equivalent that has an active, unrestricted license to practice medicine is required.
Must be eligible for licensure in the state of Louisiana.
Masters degree (MHA, MPH, MBA, MPA) preferred but not required. Board certification in a specialty recognized by the ABMS preferred.
A minimum of 3 years total administrative experience in a clinical, hospital or health plan setting. Working knowledge of the insurance industry and experience with external accreditation bodies such as JCAHO, URAC, or NCQA are preferred.
Emphasis in quality management preferred.
Experience in developing and implementing quality and efficiency profile for physicians and hospitals.
Experience in positive provider engagement and data sharing activities to improve quality and efficiency in network administration.
Strong presentation skills and ability to articulate quality concepts to all audiences.
Knowledge and experience working with Ingenix software (Impact-Pro, Impact-Intelligence) or other measurement software packages is preferred.
Prior experience in the managed care industry, understanding of utilization management and disease management and how these programs affect quality and efficiency is preferred.
Excellent communication, presentation, human relation and computer skills are required.
Ability to travel 10% and work extended hours.
ACCOUNTABILITIES:
Oversees quality improvement initiatives, quality and efficiency measurement, provider profiling and reward and recognition programs in order to help ensure that quality based products are offered and serviced.
Directs the development of valid, reliable measurement processes to aid in the determination of the quality of care members receive and provides expertise and guidance to others contributing to the process of standards and guideline development.
Integrates all aspects of quality improvement including medical home concept, chronic disease management, and quality improvement in commercial and Medicaid populations in order to help serve the companys mission.
Serves as a knowledge expert for continuous quality improvement programs in order to conceptualize focused quality improvement programs based on objective data and its impact on decreasing unnecessary utilization and own the implementation of these programs including but not limited to coaching of the case managers and other clinical staff.
Acts as internal expert for URAC and NCQA accreditation, HEDIS and CAHPS standards interpretation and implementation and coordinates regulatory activities to ensure integration and cohesion throughout the division.
Provides strategic guidance to the Marketing and Sales teams as they work with employer groups and develop new product offerings under the guidance of the Chief Medical Officer to ensure help ensure that quality based products are offered.
Provides leadership, strategic direction and management support for wellness, health management and population management programs under healthcare reform that improve health outcomes, reduce hospital readmissions, improve patient safety and reduce medical errors, as well as support applicable health plan accreditation standards and HEDIS measures.
This position reports to the Senior Vice President & Chief Medical Officer. Grade: 26.
Details:
Job Id:
27005099
Posted / Updated:
5/18/2012 6:40:16 AM
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