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Professional - Non-Clinical
Mgr Quality& Outcomes Mgmt-HP
Houston, TX, US
We’re searching for a Quality & Outcomes Improvement Manger, someone who’s ready to be part of the best ranked children’s hospital in Texas, and among the best in the nation. In this position, you will oversee day-to-day operations and manage QI staff. You’ll also assist in planning, implementing, and leading the Quality Improvement Program, covering clinical and operational aspects. Ensure compliance with regulatory requirements and accreditation standards.
Think you’ve got what it takes?
Job Duties & Responsibilities
• Manages Quality Improvement Specialists and ensures the consistent implementation of quality outreach to network providers.
• Assesses the skills and effectiveness of Quality Improvement Specialists in their interactions with providers and implements program changes to enhance their effectiveness.
• Takes responsibility for training Texas Children’s Health Plan Quality Specialists to maintain a comprehensive and up-to-date knowledge base for addressing provider and customer issues.
• Ensures Quality Specialists promptly and accurately respond to the needs of Credentialing, Medical Management, Provider Relations, Special Investigations Unit, and Operations.
• Demonstrates Quality Improvement management skills by using appropriate methodology, analysis, and facilitation techniques.
• Conducts ongoing analysis of claims data to identify areas for quality and performance improvement.
• Identifies trends, patterns, and knowledge deficits.
• Collaborates with the Director of Quality and Outcomes Management to develop intervention plans, ensure timely implementation, monitor outcomes, and make adjustments as necessary to achieve continuous quality improvement.
• Collaborates with the Director of Quality and Outcomes Management in responding to regulatory audits.
Skills & Requirements
• Bachelor's Degree Required
• RN - Lic-registered Nurses Or CPHQ - Cert-cert Prof Healthcare Qual Licenses Preferred
• 5 Years Of Quality Improvement, Medical Management Or Compliance Experience In A Healthcare Setting Required
• 2 Years Managed Care Organization Or Health Plan Experience Preferred
About Texas Children’s
Founded in 1996, Texas Children’s Health Plan is the nation's first health maintenance organization (HMO) created just for children. We provide STAR/Medicaid and Children's Health Insurance Program (CHIP) to pregnant women, teens, children and adults in Houston and surrounding areas. Currently, the Health Plan has more than 375,000 members who receive care from our network of more than 1,100 primary care physicians, 3,200 specialists, and 70 hospitals. Texas Children's Health Plan is also the largest combined STAR/CHIP Managed Care Organization in the Harris County service area.
To join our community of 14,000+ dedicated team members, visit texaschildrenspeople.org for career opportunities.
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.
