Description:
Coventry Health Care is a $14 billion growth oriented national managed health care company with corporate headquarters located in Bethesda, MD with 14,000 employees in 48 states. We provide a full range of risk and fee-based managed care products and services to a broad cross section of employer and government-funded groups, government agencies, and other insurance carriers and administrators. Coventry is currently ranked third on FORTUNES’s list of most admired insurance and managed care companies.
GENERAL SUMMARY
Directs the quality improvement activities for an assigned region. Establishes strategic plans, policies, and procedures within the region. Interfaces with all business areas to ensure quality programs will meet or exceed guidelines and requirements.
ESSENTIAL RESPONSIBILITIES
-Ensures compliance with all State and Federal quality regulations, Coventry quality standards, and National Committee for Quality Assurance (NCQA) standards.
-Ensures the maintenance of accurate documentation of all quality improvement activities, i.e., surveys, audits, peer reviews, etc.
-Remains current with new developments in the field of quality improvement.
-Develops and implements new quality improvement activities within an assigned region.
-Ensures all quality improvement activities are conducted according to Coventry quality standards and all appropriate data and documentation is retained.
-Ensures that quality improvement information, including the monitoring and evaluation of indicators, is collected and reported to the appropriate oversight committees.
-Directs data collection for Healthcare Effectiveness Data and Information Set (HEDIS) measures; identifies opportunities for improvement based on the HEDIS results.
-Works closely with regional and corporate HEDIS and Stars improvement teams to optimize overall outcomes.
-In conjunction with senior medical management, responsible for preparing the agenda and directing the activities of the Regional Quality Improvement Committee.
-May direct the medical/case record review process; ensures maintenance of medical/case record standards.
-Controls expenses while meeting operational, functional, and service requirements.
-Recruits, develops, and motivates staff. Initiates and communicates a variety of personnel actions including employment, termination, performance reviews, salary reviews, and disciplinary actions.
- Performs other duties as required.
Qualifications:
JOB SPECIFICATIONS
-Bachelor’s degree or equivalent experience. Master’s degree preferred.
-Minimum of 5 years managed care experience with emphasis in quality improvement.
-Previous (3-5 years) quality improvement experience required.
-Minimum of 3 years management/leadership experience required.
-Certified Professional in Healthy Quality (CPHQ) preferred.
-Extensive knowledge of Quality Program Implementation.
-Excellent organizational, managerial, and analytical skills required.
- Strong understanding of accreditation, federal, and state regulations/requirements.DISCLAIMER: The above statements are intended to describe the general nature and level of work being performed by individuals assigned to this position. They are not intended to be construed as an exhaustive list of responsibilities, duties and skills required of personnel so classified.
Job: Executive/Senior Level Officials and Managers
Primary Location: Overland Prk, KS, US
Other Locations: Omaha-Nebraska-United States,St. Louis-Missouri-United States,Wichita-Kansas-United States,Champaign-Illinois-United States,Urbandale-Iowa-United States,
Organization: 13000 - CHC of Kansas
Schedule: Full-time
Job Posting: 2013-06-24 00:00:00.0
Job ID: 1312126
Coventry Health Care is a $14 billion growth oriented national managed health care company with corporate headquarters located in Bethesda, MD with 14,000 employees in 48 states. We provide a full range of risk and fee-based managed care products and services to a broad cross section of employer and government-funded groups, government agencies, and other insurance carriers and administrators. Coventry is currently ranked third on FORTUNES’s list of most admired insurance and managed care companies.
GENERAL SUMMARY
Directs the quality improvement activities for an assigned region. Establishes strategic plans, policies, and procedures within the region. Interfaces with all business areas to ensure quality programs will meet or exceed guidelines and requirements.
ESSENTIAL RESPONSIBILITIES
-Ensures compliance with all State and Federal quality regulations, Coventry quality standards, and National Committee for Quality Assurance (NCQA) standards.
-Ensures the maintenance of accurate documentation of all quality improvement activities, i.e., surveys, audits, peer reviews, etc.
-Remains current with new developments in the field of quality improvement.
-Develops and implements new quality improvement activities within an assigned region.
-Ensures all quality improvement activities are conducted according to Coventry quality standards and all appropriate data and documentation is retained.
-Ensures that quality improvement information, including the monitoring and evaluation of indicators, is collected and reported to the appropriate oversight committees.
-Directs data collection for Healthcare Effectiveness Data and Information Set (HEDIS) measures; identifies opportunities for improvement based on the HEDIS results.
-Works closely with regional and corporate HEDIS and Stars improvement teams to optimize overall outcomes.
-In conjunction with senior medical management, responsible for preparing the agenda and directing the activities of the Regional Quality Improvement Committee.
-May direct the medical/case record review process; ensures maintenance of medical/case record standards.
-Controls expenses while meeting operational, functional, and service requirements.
-Recruits, develops, and motivates staff. Initiates and communicates a variety of personnel actions including employment, termination, performance reviews, salary reviews, and disciplinary actions.
- Performs other duties as required.
Qualifications:
JOB SPECIFICATIONS
-Bachelor’s degree or equivalent experience. Master’s degree preferred.
-Minimum of 5 years managed care experience with emphasis in quality improvement.
-Previous (3-5 years) quality improvement experience required.
-Minimum of 3 years management/leadership experience required.
-Certified Professional in Healthy Quality (CPHQ) preferred.
-Extensive knowledge of Quality Program Implementation.
-Excellent organizational, managerial, and analytical skills required.
- Strong understanding of accreditation, federal, and state regulations/requirements.DISCLAIMER: The above statements are intended to describe the general nature and level of work being performed by individuals assigned to this position. They are not intended to be construed as an exhaustive list of responsibilities, duties and skills required of personnel so classified.
Job: Executive/Senior Level Officials and Managers
Primary Location: Overland Prk, KS, US
Other Locations: Omaha-Nebraska-United States,St. Louis-Missouri-United States,Wichita-Kansas-United States,Champaign-Illinois-United States,Urbandale-Iowa-United States,
Organization: 13000 - CHC of Kansas
Schedule: Full-time
Job Posting: 2013-06-24 00:00:00.0
Job ID: 1312126