Mgr Managed Care

• Provides direction to a team of professionals to ensure a high-level of competency, productivity, and accountability that supports the achievement of strategic priorities within established timelines.
• Leads the creation and implementation of the improvement plan for their assigned Patient Service Areas. Oversees the implementation of improvement plans developed by team members for their assigned clinicians / clinics / practices. Uses sophisticated analytical thought and data to guide problem solving and identify innovative solutions. Applies AAH quality and high reliability improvement frameworks, methodologies, and tools, evidence-based practice, and data analysis to achieve optimal outcomes.
• Leads the development and adoption of processes and mechanisms for accurate quality data collection, analysis and reporting. Reviews and analyzes quality data for accuracy, patterns, and trends.
• Keeps current on external reporting programs, associated measures, and best practices in order to ensure internal priorities align with external environment and demands.
• Provides leadership and consultative services to assigned areas. Collaborates with other department leaders in an effort to optimize quality improvement processes and meet quality and assigned risk contract goals. Promotes cross-departmental communication, collaboration, and performance improvement. Serves as a resource and mentor to colleagues with less experience.
• Manages and leads multidisciplinary quality studies for clinical improvement. Identifies opportunities for improvement, makes recommendations for change, and leads the implementation of evidence based and best practices to meet established goals.
• Ensures all key stakeholders receive consistent communication about current quality performance, improvement opportunities and expectations.
• Drives development of improved Electronic Health Record (EHR) tools to support patient care and Quality improvement initiatives in collaboration with key functional departments and leadership. Ensures stakeholders receive education on appropriate use of EHR tools.
• Leads the development and maintenance of educational materials related to quality initiatives. Provides training/educational programs and in-services to team members as well as other clinical and nonclinical audiences.
• Performs human resources responsibilities for staff which include interviewing and selection of new employees, promotions, staff development, performance evaluations, compensation changes, resolution of employee concerns, corrective actions, terminations, and overall employee morale.
• Develops and recommends operating and capital budgets and controls expenditures within approved budget objectives.
• Responsible for understanding and adhering to the organization’s Code of Ethical Conduct and for ensuring that personal actions, and the actions of employees supervised, comply with the policies, regulations and laws applicable to the organization’s business.

Licensure, Registration, and/or Certification Required:

• None Required.

Education Required:

• Bachelor’s Degree in Health Care Administration or related field, or
• Bachelor’s Degree in Quality Management or related field.

Experience Required:

• Typically requires 5 years of experience in health care, clinical quality improvement, project management. Includes 1 year of supervisory experience in care management or quality improvement.

Knowledge, Skills & Abilities Required:

• Advanced knowledge of quality improvement methodologies (e.g. PDSA, Lean, Six Sigma, Juran, etc.), improvement planning and independent effective resolution of complex problems.
• Demonstrated knowledge of integrated health care operations and value based health care models.
• Demonstrated ability to organize and manage multiple projects across multiple venues and multiple geographies.
• Excellent analytical and statistical skills with ability to analyze complex data, make inferences, and validate conclusions.
• Excellent facilitation, verbal and written communication skills.
• Broad understanding of how Information System tools support quality improvement.
• Understanding of health care delivery system and dynamics within a large complex, highly matrixed environment.
• Proficiency with MS Office and ability to create reports, graphs, and other visual presentation materials, and effectively maintain statistical data.
• Ability to research and critique strength of evidence based and best practice recommendations.

Physical Requirements and Working Conditions:

• Generally exposed to a normal office environment.
• Operates all equipment necessary to perform the job

This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.