Director of Quality and Outcomes Management-Health Plan

 
Position: Director of Quality and Outcomes Management-Health Plan

Job ID: 150464

Location: US-TX-Bellaire

Department: Administration-TC Health Plan

Talent Area: Professional - Clinical

Full/Part Time: Full-Time

Regular/Temporary: Regular

Shift: Monday-Friday 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 14,000+ dedicated team members, visit texaschildrenspeople.org for career opportunities. You can also learn more about our amazing culture at infinitepassion.org.

Summary:

We are searching for a Director of Quality and Outcomes Management — a talented, passionate individual who is a strong collaborator. In this position, you’ll lead the Health Plan’s quality improvement program which aims to achieve the best health outcomes for our members by ensuring the plan meets the highest standards, delivering high quality service to our provider network and promoting programs which support our network providers to deliver exceptional care to our members. You will oversee the accreditation of internal health plan operations You will work with the quality team to develop innovative strategies and implement best practices to meet the quality objectives of the Health Plan and the state. Finally, you will assist various departments in the identification, monitoring, assessment, and reporting of all overall performance improvement processes.

Think you’ve got what it takes?



Responsibilities :

Works directly with Senior Executives to continuously evaluate and revise the quality improvement program based upon the health needs of members, accreditation, and regulatory/contract requirements
• Plan, organize and direct the identification, prioritization and implementation of strategic projects that improve financial, service and clinical outcomes for the Health Plan.
• Oversee quality improvement team and coordinate departmental functions with care management, claims administration, network development, information systems, member services, finance, and the integrated delivery system
• Direct credentialing/re-credentialing ensuring that the processes they are compliant with accrediting, regulatory, and contractual requirements
• Provides primary oversight and responsibility for the Health Plan’s Quality Committee structure and support.
• Responsible and accountable for QAPI program activities and for the ongoing maintenance of the Health Plan’s compliance with state regulations, NCQA and other appropriate standards for activities related to Quality
• Submit performance planning documents, ongoing planning materials, actions plans, and department goals



Qualifications:

Bachelor’s degree required
• Master’s degree or Ph.D. preferred
• RN or RPH certification required
• 4 years’ experience in quality, medical management, compliance, or another related clinical experience
• CERTPHQ certification, Medicaid Health Plan experience, 3 years’ leadership experience, and a nursing background preferred



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