Manager Quality & Outcomes Utilization Management

About Texas Children's Hospital

Summary:

We are searching for a Manager of Quality & Outcomes Management - 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 to plan, organize, implement, and lead the Quality Improvement Program that encompasses both the clinical and operational aspects of the department. The QI Manager assists in developing the strategic plan, enforces policies and procedures, updates the annual QI Program documents including QI Program Description, work plans and annual evaluation. The QI Manager must have an understanding of 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.

Someone with previous experience working for a Managed Care Organization or Health Plan is highly preferred. 

Think you’ve got what it takes?

Qualifications:

• Bachelor’s degree required
• RN license from the Texas Board of Nursing or Nursing Licensure Compact preferred
• CPHQ certification preferred
• 5 years quality improvement, medical management or compliance experience in a healthcare setting required
• 2 years managed care organization or health plan experience required

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 Health Plan Quality Specialists to ensure a comprehensive, up to date knowledge base for dealing with provider and other customer issues
• Responsible for Quality Specialists' functions, assuring quick, accurate response to Credentialing, Medical Management, Provider Relations, Special Investigations Unit and Operations needs
• Demonstrates Quality Improvement management skills as evidenced by utilization of appropriate methodology, analysis and facilitation skills
• Develops plans for interventions, assures timely implementation, monitors outcomes, and adjusts interventions as needed to assure continuous quality improvement
• Responsible for ongoing analysis of claims data to identify needs for quality/performance improvement