Program Manager, Quality Improvement

Job Description

Job Description

Position Summary:

The Program Manager, Quality Improvement supports the organization’s quality performance goals, particularly around HEDIS measures, and assists with administrative functions related to NCQA accreditation and survey preparation. This position plays a key role in tracking performance metrics, supporting data submission processes, and contributing to ongoing quality improvement initiatives.

Essential Duties and Responsibilities:

1. Track and monitor HEDIS performance across the organization according to contracted benchmarks.

1. Use HEDIS tracking tools to identify gaps and communicate needed outreach activities to relevant teams.

1. Assist in the coordination and administrative support of accreditation processes.

1. Maintain accurate records of accreditation tasks and timelines.

1. Prepare and assist with submission of periodic reports required by accrediting and regulatory agencies (AHCA, FHKC, NCQA, EQRO).

1. Communicate and report performance trends and data quality issues to the quality improvement team.

1. Support the training and knowledge-sharing efforts for patient outreach processes by providing subject matter expertise.

1. Assist with external payer collaborations, including data file submissions and participation in quality performance discussions.

1. Perform other duties as assigned.

This job description in no way states or implies that these are the only duties performed by the employee occupying this position. Employees will be required to perform any other job-related duties assigned by their supervisor or management.

Qualifications:

• Bachelor’s degree in healthcare administration, or a related healthcare field required.
• Three (3) years of healthcare experience.
• Two (2) years of Managed Care experience.
• Knowledge of HEDIS, performance measures, and NCQA accreditation.
• Proficiency in Microsoft Office applications (Word, Excel, PowerPoint, etc.)
• Proficiency in Electronic Health Record (EHR) system documentation/extraction.
• Florida driver’s license and reliable mode of transportation for practitioner site meetings and education.

Skills and Abilities:

• Ability to maintain strict confidentiality and handle sensitive information.
• Analytical and Reporting skills.
• Capable of leading team members on projects to successful completion.
• Strong interpersonal, organizational, and communication skills.
• Self-motivated.

Work Schedule:

Community Care Plan is currently following a hybrid work schedule. The company reserves the right to change the work schedules based on the company needs.

Physical Demands:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to sit, use hands, reach with hands and arms, and talk or hear. The employee is frequently required to stand, walk, and sit. The employee is occasionally required to stoop, kneel, crouch or crawl. The employee may occasionally lift and/or move up to 15 pounds.

Work Environment:

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of the job. The environment includes work inside/outside the office, travel to other offices, as well as domestic, travel. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

The noise level in the work environment is usually moderate.

We are an equal opportunity employer who recruits, employs, trains, compensates and promotes regardless of age, color, disability, ethnicity, family or marital status, gender identity or expression, language, national origin, physical and mental ability, political affiliation, race, religion, sexual orientation, socio-economic status, veteran status, and other characteristics that make our employees unique. We are committed to fostering, cultivating, and preserving a culture of diversity, equity, and inclusion.