Assistant Director of Quality Outcomes Management HealthPlan

Position: Assistant Director of Quality Outcomes Management HealthPlan

Job ID: 145557

Location: US-TX-Houston

Department: Quality Management

Talent Area: Professional - Non-Clinical

Full/Part Time: Full-Time

Regular/Temporary: Regular

Shift: 8a-5p

About Texas Children's Hospital

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 13,000 dedicated team members, visit for career opportunities. You can also learn more about our amazing culture at



We are searching for an Assistant Director of Quality Outcomes Management for Health Plan — someone who works well in a fast-paced setting. In this position, you'll provide leadership to the Medical Staff, Health Plan Leadership and Staff by contribution to and maintaining continuity in the planning, development and implementation of policies, procedure and standards applicable to the quality program. Activities involve assisting Health Plan departments in maintaining compliance with all Health Plan policies and procedures regarding identification, monitoring, assessment, reporting and follow up activities related to the overall performance improvement process. You will be responsible for training, assessing, and coaching Quality Nurses in the utilization of quality methodology appropriate for their assigned quality improvement initiatives. You will also be responsible for monitoring the Quality Nurses' effective use of communication techniques and assesses the appropriateness of their interpersonal skills in working with physicians and other providers. Lastly, you will be responsible for annual inter-rater reliability testing of Quality Nurses' interpretation of physician audit tools and development of staff training programs based on findings.

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Responsibilities :

  • Manages Quality Improvement Nurses and assures consistent implementation of quality outreach to network providers. Assesses Quality Improvement Nurses’ skills and effectiveness of provider interactions and implements program changes to increase effectiveness
  • Actively commits to the on-going development of self and department staff to achieve professional goals. Coaches, develops and manages staff to assure continual refinement and development of new skills
  • Partners with staff, medical staff, and health plan leadership to ensure excellence in the performance improvement, outcomes management, and accreditation programs as evidenced by trend identification and regulatory agency reports of compliance
  • 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
  • Ensures that NCQA requirements specific to the Health Plan Quality are fulfilled and understands the linkage between Texas Children’s Health Plan Quality department’s requirements and those of the integrated delivery system
  • Collaborates with colleagues in other departments to ensure all NCQA requirements are met
  • Strives to achieve the goal of accreditation
  • Responsible for TDI requirements



  • Bachelor's Degree in Nursing (BSN)
  • RN - Licensed Registered Nurses
  • 5 years of quality, medical management and/or compliance experience
  • prefer quality experience in a Healthplan organization
  • NCQA accredidation experience preferred


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