Quality Improvement Supervisor, South San Francisco, CA
QUALITY IMPROVEMENT SUPERVISOR
The Health Plan of San Mateo (HPSM), a managed care health plan, seeks a full time Quality Improvement Supervisor who will be responsible for the development and implementation of designated Quality Programs which include HEDIS, Facility Site Review (FSR) and Physical Accessibility Review (PAR). This position will assist the QI Manager in the implementation of quality programs consistent with HPSM’s Quality Department goals. The essential duties and responsibilities will include the following:
- Supervise assigned staff by communicating job expectations; training, planning, monitoring, and appraising job results; coaching, counseling, and implementing corrective action steps when necessary; developing, coordinating, and enforcing systems, policies, procedures, and productivity standards.
- Oversee activities of HEDIS and FSR/PAR program, resources and processes to achieve program improvement, including assignment of staff/nurses, adherence to plan timelines, and vendor oversight for timeliness and quality.
- Provide comprehensive analysis of measures, barriers, and opportunities, and present results of improvement efforts and ongoing performance measures to management.
- Evaluate current processes for the specific program and perform routine opportunity assessments to determine the effectiveness of interventions/incentives and offer replacements as necessary.
- Provide strategic options to connect activities, incentives and compensation to quality outcomes.
- Lead cross functional teams as required which may include other departments including Quality, Health Services, Provider Services, Project Management and IT.
- Implement performance improvement programs as part of primary care incentive programs and evaluate, recommend, deploy appropriate tools/technology or internal reporting processes to report on periodic progress for success outcomes and compliance to regulatory requirements.
- Ensure compliance for quality audits and maintains data and process controls.
- Deploy report tools/processes to users and stakeholders as needed.
- Develop and implement a site review plan to meet the needs of the department. Conduct or supervise medical and facility site reviews (FSRs) and physical accessibility reviews (PARs); perform site reviews, enter data into database, produce and mail results to providers; and conduct pre-contractual reviews with potential contracted providers.
- Lead in periodic and annual required activities of assigned program; Lead the preparation of, validation and submission of required reports to DHCS for FSR activities, scores, etc.
- Participate in the analysis of study findings and reports.
- Supervise annual HEDIS activities, oversight and training to other QI nurse(s). Work is completed in concert with the Medical Director, the Senior Health Statistician, QI Nurse, and other appropriate HPSM staff.
- Project Lead for HPSM with outside vendor(s) for chart review activities. Manage vendor oversight and adherence to contractual obligations.
- Facilitate annual NCQA HEDIS ROADMAP and specified HEDIS audit processes for HPSM. Assist HEDIS Auditors in obtaining supportive documentation for audit.
- Participate in HEDIS conference calls/training including attendance at the annual NCQA HEDIS Update conference and attend the Onsite HPSM Audit prior to the beginning of HEDIS.
- Actively support and participate in audits, conference calls and meetings, training, program oversight activities, conferences and other related activities specific to program needs.
- Serve as a knowledge expert for Quality Improvement Program and act as the conduit for information for the Department and the nursing team to and from DHCS, the provider community, etc.
Education and Experience: Must be a California Registered Nurse. Bachelor’s degree in health care field preferred. Equivalent to at least three (3) years of work in a health care or managed care environment with responsibility for researching, analyzing, planning, evaluating or coordinating projects. Advanced working knowledge of HEDIS specifications. Certification as a state FSR Master Trainer is preferred.
Knowledge of: Supervisory principles and practices as well as techniques and methods to organize and manage direct reports. Principles, practices and trends of project management and business administration. Medicare and Medi-Cal and regulatory programs. Quality tools: experience with training and facilitation. Effective leadership techniques. Data analytics. Personal computers and proficiency in Microsoft Office Suite applications, including Outlook, Word, Excel, Access and PowerPoint.
Ability to: Utilize personal computers and Microsoft Office products (Word, Excel, Access and Outlook). Excellent oral and written communication skills. Demonstrated ability to function effectively as team player within HPSM and across organizations. Ability to use initiative and work independently; organize workload/projects and handle multiple projects simultaneously. Lead and collaborate effectively with a variety of people in many different settings. Starting Compensation Range: Between $81,884 - $118,574 – depending on experience.
Other: Must have own vehicle and valid driver’s license with proof of insurance in conformity with state law minimums and be willing to travel (primarily) in San Mateo County.
Benefits Information: Excellent benefits package offered, including HPSM paid premiums for employee’s coverage in the medical HMO plan and majority of PPO medical cost. Employee pays a small portion of the dependent premiums for medical and dental benefits. Additional HPSM benefits include fully paid vision, life, AD&D, STD, and LTD insurance; retirement plan (10% of salary for compensation/HPSM paid); holiday and vacation pay; tuition reimbursement plan; and more.
Application Process: To apply, submit a resume and cover letter with salary expectations to: Health Plan of San Mateo, Human Resources Department, 801 Gateway Blvd., Suite 100, South San Francisco, CA 94080 or via email: firstname.lastname@example.org or via fax: (650) 616-8039. File by: Continuous until filled. EOE