Manager Quality & Outcomes Management -HP

 
Position: Manager Quality & Outcomes Management -HP

Job ID: 163165

Location: US-TX-Houston

Department: Quality Management

Talent Area: Registered Nurse

Full/Part Time: Full-Time

Regular/Temporary: Regular

Shift: 8a-5p REMOTE

About Texas Children's Hospital

Texas Children’s Hospital Since 1954, Texas Children’s has been leading the charge in patient care, education, and research to accelerate health care for children and women around the world. When you love what you do, it truly shows in the smiles of our patient families, employees and our numerous accolades such as being consistently ranked as the best children’s hospital in Texas, and among the top in the nation by U.S.News & World Report as well as recognition from Houston Business Journal as one of this city’s Best Places to Work for ten consecutive years. Texas Children’s comprehensive health care network includes our primary hospital in the Texas Medical Center with expertise in over 40 pediatric subspecialties; the Jan and Dan Duncan Neurological Research Institute (NRI); the Feigin Center for pediatric research; Texas Children’s Pavilion for Women, a comprehensive obstetrics/gynecology facility focusing on high-risk births; Texas Children’s Hospital West Campus, a community hospital in suburban West Houston; and Texas Children’s Hospital The Woodlands, the first hospital devoted to children’s care for communities north of Houston. We have also created the nation’s first HMO for children, established the largest pediatric primary care network in the country and a global health program that is channeling care to children and women all over the world. Texas Children’s Hospital is also academically affiliated with Baylor College of Medicine, one of the largest, most diverse, and successful pediatric programs in the nation.   To join our community of 14,000 dedicated team members, visit texaschildrenspeople.org for career opportunities. You can also learn more about our amazing culture at infinitepassion.org.  At Texas Children’s Hospital, diversity, equity, and inclusion are at the core of our values and mission for all of our patients and families that we serve. We are committed to providing a diverse and inclusive work environment for all faculty, staff, and learners throughout our organization. We believe that each member of our one amazing team provides enrichment that allows us to create a lasting legacy for future employees of this great organization.   Texas Children’s is proud to be an equal opportunity employer. All applicants and employees are considered and evaluated for positions at Texas Children's without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, gender identity, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.

Summary:

We are searching for a Quality Improvement Manager -- someone who works well in a fast-paced setting. In this position, you will be responsible for the day-to-day operations and management of the QI staff. The QI Manager assists the Director of Quality in planning, organizing, implementing, and leading the Quality Improvement Program that encompasses both the clinical and operational aspects of the department. The QI Manager assists in developing the strategic plan enforcing policies and procedures and updates the annual QI Program documents including QI Program Description, work plans, and annual evaluation. The QI Manager must understand the State regulatory requirements, NCQA Accreditation standards, and HEDIS reporting. The QI Manager can skillfully apply techniques of CQI, TQM, quality improvement, outcomes measurement, and statistical analysis.

 

Think you’ve got what it takes?



Responsibilities :

  • Manages Quality Improvement Specialists and assures consistent implementation of quality outreach to network providers
  • Assesses Quality Improvement Specialists’ skills and effectiveness of provider interactions and implements program changes to increase effectiveness.
  • Responsible for training of Texas Children’s Health Plan Quality Specialists to ensure a comprehensive, up-to-date knowledge base for dealing with the provider and other customer issues
  • Responsible for Quality Specialists' functions, assuring quick, accurate response to Credentialing, Medical Management, Provider Relations, Special Investigations Unit, and Operation’s needs
  • Demonstrates Quality Improvement management skills as evidenced by utilization of appropriate methodology, analysis, and facilitation skills
  • Responsible for ongoing analysis of claims data to identify needs for quality/performance improvement
  • Identify trends, patterns, and knowledge deficits
  • With the Director, Quality and Outcomes Management develops plans for interventions, assures timely implementation, monitors outcomes, and adjusts interventions as needed to assure continuous quality improvement
  • With the Director, Quality and Outcomes Management, responsible for responses to regulatory audits


Qualifications:

Being fully vaccinated against COVID-19, including any booster dose(s) of the COVID-19 vaccine recommended by the Centers for Disease Control when eligible, is required for all employees at Texas Children’s unless approved for a medical or religious exemption

  • Bachelor's Degree
  • Licenses/Certifications: preferred RN - Lic-Registered Nurses by the Texas Board of Nursing or Nursing Licensure Compact and a CPHQ - Cert-Cert Prof Healthcare Qual
  • Required 5 years of quality improvement, medical management, or compliance experience in a healthcare setting and 2 years of managed care organization or health plan experience


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