Job Summary

Quality Improvement Director

Primary Function
Responsible for the development, implementation, and management of the following programs:

Description

Job Summary

A dynamic, leading, and national provider of clinical abstraction, analysis, and verification services of the highest quality. Maintaining this quality of service requires focused and committed time and attention. To enable this superior quality, the healthcare organization is seeking a Director of Quality Management to expand its Quality Assurance department.

Job Summary

Job Summary

Oversee medical management operations in the health plans. Ensure all Health Plans attain annual health benefits ratio (HBR) targets. Implement and evaluate new and existing projects and processes developed by corporate medical management. Assist in measuring the impact and outcomes of medical management initiatives.

Knowledge/Experience
Bachelor's degree in related field. Master’s degree preferred. 8-10 years of related medical management experience. Analytical skills and Six Sigma experience preferred. Nursing degree preferred.

Job Description

Primary Function

Under the leadership of the Vice President, Health Services is Responsible for the planning, development, implementation and management of the Utilization, Chronic Care and Rapid Response programs. Monitors and implements appropriate interventions to assure achieving cost effective and quality outcomes for membership served within approved Medical Budget. Collaborates with the Sr. Medical Director and Vice President, Health Services to evaluate the effectiveness and clinical outcomes of the Chronic Care Improvement Program.