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Vice President of Clinical Quality - Health Care

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Location: San Antonio, TX

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Job Description

  

The Vice President of Quality Improvement is responsible for the day-to-day operations of the quality improvement program which includes but is not limited to developing, coordinating, and implementing quality initiatives within the health plan; initiating clinical and service performance improvement projects; monitoring of service indicators; grievance and appeals data; accessibility and availability of provider network; member and provider satisfaction; over and underutilization of services; organizational determinations; case and disease management; and delegation to other entities.  Develops and oversees a comprehensive quality improvement program that encompasses both the clinical and operational aspects of quality improvement program

  

Responsibilities

 

  • Provides leadership and support in establishing and directing the Quality Improvement Program consistent with the plan directives.

    Develops and/or maintains QI policies and procedures that meet State, Federal legal requirements and standards.

    Collaborates with physicians to design and oversee implementation of the clinical quality improvement initiatives.

    Works closely with the Compliance Officer to maintain compliance with all business specific rules, regulations and standards: i.e. CMS

    Facilitates, integrates, and/or coordinates the development, design, implementation, and evaluation of identified quality improvement activities.

    Promotes understanding, communication and coordination of all quality improvement program components and the continuous quality improvement.

    Participates in various evaluations and audits.

    Coordinates reporting on quality initiatives to all appropriate committees by ensuring that standard owners have completed a report, performed a preliminary analysis of data, and presents the findings and recommendations for improvement.

    Effectively manages department staff to accomplish departmental goals.

    Develops operating and capital budget proposals.

    Maintains QI program documents, reports, and committee minutes and follows all internal privacy and confidentiality policies and procedures.

    Maintains current knowledge of regulatory requirements associated with the QI program.

    Oversees HEDIS data submission process.

    Leadership of accreditation efforts (URAC).

 

 


Job Requirements

 

Qualifications

  

  • Bachelor’s degree or Certificate in Registered Nursing or related field required.  (8 additional years of comparable work experience beyond the required years of experience may be substituted in lieu of a bachelor’s degree.)
  • Current RN Licensure.
  • 3-5 years experience in quality improvement in a managed care environment and/or large physician practice setting. 
  • 2-3 years supervisory experience.
  • Must have a basic understanding with quality improvement standards such as NCQA, TDI, TDH and Medicare.
  • Must have actively worked with quality improvement standards from Regulatory agencies
  • Facilitated and coordinated QI committees’ activities.
  • Strong teamwork, interpersonal and customer service skills.Certified Professional in Healthcare Quality (CPHQ).

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