Quality Improvement Manager Resume Sample
Riley Wyman
626 Murazik Pine,
Chicago,
IL
+1 (555) 400 9154
Work Experience
Quality Improvement Manager
08/2015
-
PRESENT
Philadelphia, PA
- In partnership with the state leadership team and QI Director, develops state specific continuous quality improvement plans
- Provides quality assurance/improvement focused technical assistance and subject matter expertise with regard to process improvement initiatives
- Partners with operations to identify training needs and to develop resources to meet those needs
- Analyzes data and proactively identifies opportunities for improvement
- Oversees the implementation of the incident reporting system according to The Network’s Incident Management Protocol
- Consults with operations to follow through on critical events and identify methods to improve safety and minimize risk to individuals in service and employees
- Works with operations team to develop policies in compliance with CQL accreditation, local regulatory standards and consistent with Network policies and protocols
- Conducts complex and higher-level internal investigations; conducts and/or reviews internal investigations involving alleged abuse and/or neglect
Quality Improvement Manager Swhp
01/2013
-
02/2015
New York, NY
- Collaborates with operations leadership to determine and implement local customer service engagement activities
- Collaborates with state leadership and QI Director to design the strategy for completing the survey process in the state; partners with operations to develop improvement plans in response to survey results
- Lead Quality Improvement Teams (QIT) and ensure implementation in the region is in alignment with ENA Quality strategies and priorities, monitor key Quality KPI’s for branches and districts, report status and ensure permanent Corrective Actions are implemented
- Analyze warranty claim and call out information to support data-driven, root cause analysis and resolution throughout the supply chain
- Support Net Promoter/Customer satisfaction actions / follow-up with business stakeholders
- Support sales with contract requirements related to Quality
- Ensure communication of relevant Product Bulletins (incl. troubleshooting instructions)
- Actively participate in project and product development to drive improved installation quality and long-term reliability
Senior Laboratory & Quality Improvement Manager
12/2006
-
07/2012
New York, NY
- Plays a critical role in performance improvement through the delivery and management of physician reports, providing feedback and education, and guiding actionable initiatives from data both as an individual contributor and through education of key market team members
- Integrate care management, risk adjustment, annual wellness visit and quality initiatives into practice and assist with program engagement
- Lead the transition of innovative ideas from pilot to implementation and share best practices across all markets
- Co-facilitate and or lead practice manager forums/meetings related to value based care initiatives
- Develop operational plans with direction from Market & Central leadership to successfully complete annual reporting requirements
- Manage the implementation and successful completion of the ACO’s quality improvement program
- Identify and prioritize key quality and utilization initiatives critical to client success under its performance based payment programs (e.g., achieving target thresholds for ACO Medicare Shared Savings Program, pay-for-performance contracts with national payers, etc.)
- Support care gap closure through physician practices, nurse care manager/pharmacist interactions, and patient communications and education
- Prepare and present reports and updates for internal and external client committees (e.g., ACO Quality Committee)
Education
Upper Iowa University
2000 - 2005
Bachelor's Degree in Business Administration
Professional Skills
- Demonstrated ability in problem solving and excellent organizational/time management skills
- Expertise in computers, Microsoft Office (Word, Excel), operate office equipment, good interpersonal/communication/problem solving skills
- Strong communication and presentation skills employing MS PowerPoint required
- Supervising and training staff, including mentoring skills, and conducting performance reviews
- Continually strives to improve own skills and competencies by demonstrating initiative to participate in ongoing coaching and training programs
- Prior experience writing, developing and/or implementing a quality program
- Experience quality analysis, 3+ years experience managing and developing high-performing teams
How to write Quality Improvement Manager Resume
Quality Improvement Manager role is responsible for training, microsoft, analysis, finance, integration, database, procurement, auditing, purchasing, reporting.
To write great resume for quality improvement manager job, your resume must include:
- Your contact information
- Work experience
- Education
- Skill listing
Contact Information For Quality Improvement Manager Resume
The section contact information is important in your quality improvement manager resume. The recruiter has to be able to contact you ASAP if they like to offer you the job. This is why you need to provide your:
- First and last name
- Telephone number
Work Experience in Your Quality Improvement Manager Resume
The section work experience is an essential part of your quality improvement manager resume. It’s the one thing the recruiter really cares about and pays the most attention to.
This section, however, is not just a list of your previous quality improvement manager responsibilities. It's meant to present you as a wholesome candidate by showcasing your relevant accomplishments and should be tailored specifically to the particular quality improvement manager position you're applying to.
The work experience section should be the detailed summary of your latest 3 or 4 positions.
Representative Quality Improvement Manager resume experience can include:
- Exhibits self-directed capability to effectively interact with larger groups from a wider range of organizations, as well as reporting out to senior leadership
- Develop team members to their highest skills level; recognizing team member’s personal strengths
- Prior nursing supervisory experience
- Interpersonal communications, group process and facilitation skills
- Demonstrates ability to organize work, set priorities, meet critical deadlines and follow up on assignments with a minimal amount of direction
- Identifies opportunities to improve customer experience, efficiency, and effectiveness
Education on a Quality Improvement Manager Resume
Make sure to make education a priority on your quality improvement manager resume. If you’ve been working for a few years and have a few solid positions to show, put your education after your quality improvement manager experience. For example, if you have a Ph.D in Neuroscience and a Master's in the same sphere, just list your Ph.D. Besides the doctorate, Master’s degrees go next, followed by Bachelor’s and finally, Associate’s degree.
Additional details to include:
- School you graduated from
- Major/ minor
- Year of graduation
- Location of school
These are the four additional pieces of information you should mention when listing your education on your resume.
Professional Skills in Quality Improvement Manager Resume
When listing skills on your quality improvement manager resume, remember always to be honest about your level of ability. Include the Skills section after experience.
Present the most important skills in your resume, there's a list of typical quality improvement manager skills:
- To be curious, good with data collection and analysis. Strong and presenting, engaging to work with and able to create a good rhythm for improvement
- Strong analytical, solutioning, and implementation skills required
- Demonstrated advocacy skills with empathy and solution-orientation
- Relevant experience of 7-10 years in progressively responsible roles with demonstrated leadership experience in comparable or larger health care organization
- Health care management or consulting experience with strong understanding of performance measurement and improvement processes
- Experience in a Healthcare setting; 2+ years of experience in Quality Improvement / Measurement
List of Typical Experience For a Quality Improvement Manager Resume
1
Experience For Quality Improvement Manager Swhp Resume
- Demonstrates computer use ability in word processing, spreadsheet, database, and presentation software
- Prepare effectiveness studies on program activities to identify improved outcomes and status of meeting set objectives
- Demonstrates ability to present information to large audiences
- Experience in Performance Management, Quality Improvement, and PHAB Accreditation is desired
- Function as a consultant to evaluate the Gateway organization, analyzing processes and systems to recommend solutions regarding NCQA vulnerabilities and gaps
- Establish and maintain a PM and QI monitoring and reporting system
- Collect and analyze data for EPSDT and encounter reporting to other Gateway departments for compliance
- Works with management of implementing improvements
- Collaborates with the PPL training team to incorporate quality improvement concepts and actions into staff education curricula
2
Experience For Quality Improvement Manager RN Resume
- Participates in preparing the budget for the program
- Researches, designs and maintains organization-wide PM and QI training
- Supports Fee-for-Service Medicaid programs in the development of quality oversight process, including identification of key performance measures
- Problem solving- the ability to use relevant information to develop recommendations and solution options to identified problems and organize to resolution
- Assess critical and complex situations and give analytical solutions
3
Experience For Senior Laboratory & Quality Improvement Manager Resume
- Manage the implementation and successful completion of the quality improvement program
- Identify and prioritize key quality and utilization initiatives critical to client success under its performance based payment programs (e.g., achieving target thresholds for Medicaid and Medicare ACO programs, pay-for-performance contracts with national payers, etc.)
- Prepare and present reports and updates for internal and external client committees
- Receive and respond to regulatory requests for data such as those from State Boards, Governor’s Office, legislators/Legislature, CMS, CDC, etc
- Extensive background and knowledge of quality improvement principles and accreditation bodies’ review processes (NCQA, JC, URAC, HEDIS, CMS Core Measures)
- Prepares and provides to the Department an annual quality management program evaluation that summarizes the ASO’s and Providers’ performance for the year
- Interfaces with the Department on quality programs, including participating in the Department’s QMI activities as requested
- Prior experience in developing and implementing laboratory program initiatives, laboratory strategic planning, laboratory accreditation programs, quality management systems, referral systems, supply chain management systems, and use of electronic laboratory information systems
4
Experience For Regional Business & Quality Improvement Manager Resume
- Internal staff and management at all levels, including senior leadership
- Provide day-to-day leadership and representation for the Quality Improvement Department/Quality Improvement Program both internally and externally
- Assist Director in the planning, design, development and implementation of the Quality Improvement Department Strategic Plan based upon the strategic initiatives and direction of the organization
- Monitor and report, on a regular basis, the status of the QI Department Strategic Plan initiatives and activities
- Present quality improvement program information within the Gateway organization, and externally to Gateway’s committees, regulatory bodies, professional organizations, business partners, delegates, and vendors
- Provide leadership and direction for direct report staff and matrixed employees to ensure department activities are performed and strategic initiatives are accomplished. Conduct performance reviews and ongoing staff development
- Coordinate the successful definition, development, implementation delivery and monitoring of the quality portion of the Quality Improvement/Utilization Management Program and Work Plan
- Collaborate with all Departments to initiate cross-functional quality improvement related teams, activities, programs and services. Ensure Total Quality Management (TQM) concepts are utilized in the development, implementation, monitoring and evaluation of all quality activities, programs and services
5
Experience For Quality Assurance & Quality Improvement Manager Resume
- Ensure the standards of the National Committee for Quality Assurance (NCQA) and all applicable State and Federal Regulatory Agencies are appropriately integrated into the Quality Improvement/Utilization Management Program
- Assist in the preparation of the annual QI budget based upon the QI Strategic Plan, established quality improvement program activities and responsibilities, and the fiscal direction of the organization
- Assist in the planning and preparations for external audits and surveys, including but not limited to NCQA Accreditation Surveys, CMS, Department of Public welfare, Department of Health. Evaluate, recommend and implement processes and programs as necessary to maintain NCQA compliance
- Assist in evaluating the NCQA standards against all applicable State and Federal Regulatory Agency standards and ensure that appropriate compliance has been determined utilizing the most stringent standards or according to fixed rules and regulations
- Oversee and lead the organization-wide HEDIS Business Process within Gateway Health Plan, which includes HEDIS, CAHPS and HOS
- Annually, in collaboration with all involved departments, evaluate the HEDIS Business Process to identify systems issues, process inefficiencies, training or education gaps, and lapses in communication. Perform barrier analysis and identify opportunities for improvement
6
Experience For HIM Quality Improvement Manager Resume
- Collaborate within all Gateway Departments to analyze HEDIS performance rates against Quality Compass benchmarks. Develop, implement and monitor interventions and activities to improve HEDIS and Pay for Performance (P4P) measures outcomes
- Lead and manage the on-site Quality Improvement activities for Gateway, including the following
- Conduction of on-site visits and medical record reviews via nurse reviewers to assess the care provided in the practice setting in compliance with Gateway and external requirements
- Aggregate data to identify network wide opportunities for improvement and the development of action plans to address the findings
- Conduct site visits and medical record reviews for high volume specialists and facilities in accordance with Gateway and external requirements
- Direct the deployment of the nurses during the HEDIS timeframe for the hybrid medical record data abstraction phase of the HEDIS survey and oversee the data entry, quality check ,inter-rater reviews and all follow up components of the process
- Lead the health care disparity efforts of the Gateway organization through collaboration and partnering to address the following
- Health care disparities that can drive improvements in HEDIS rates. Employee education and awareness efforts for improved levels of member satisfaction
7
Experience For European Quality Improvement Manager Resume
- Provider awareness and education of the role of health care disparities and literacy in overall health and outcome
- Lead the multi-disciplinary Health Care Disparities Committee to drive change across the organization
- Provide facilitation, coaching, and collaboration on projects; mentor, train, and coach team members and employees toward a continuous improvement culture; support team members in the implementation of lean process management practices. Promote staff success and conducts performance reviews in accordance with State and DES human resource policies
- Prepare written documents, such as Federal and State reports, issue papers, as requested. Participates In internal and external early childhood data system integration work-groups to ensure the program is appropriately represented
- Lead or facilitate teams in the production of effective communication regarding processes and measurements and maintain accurate tracking of projects and data to facilitate celebration of successes and identify, develop, and maintain metrics to measure the success of improvement initiatives
- Compile, prepare, and present to stakeholders and leadership analytical results with identification, quantification, and prioritization of opportunities
- Execute validation of improvements in concert with business partners
- Demonstrates and promotes a high-performance, customer-centric culture of quality
- Demonstrates ability to produce measurable contributions to RCC Operations goals and objectives
8
Experience For RN Quality Improvement Manager Resume
- Lead and manage multiple data analyses and improvement projects simultaneously within large-scale strategic improvement initiatives
- Determine and understand the effects of key factors related to people, process, and technology performance
- Lead the development of key performance metrics, dashboards, and scorecards required to measure and track critical operational performance
- Lead the design and execution of process observations, root cause analysis, and support solution identification and development
- Lead the development of new analytical methods and techniques and identify appropriate applications to data analytics
- Develop and execute comprehensive improvement action plans based on analytical findings
- Partner with Business Intelligence and other TH&N OE functions to design and execute appropriate data collection to support opportunity identification, impact assessment, metrics development, and improvement effectiveness determination
- Identify and specify additional data necessary to characterize critical process parameters and fill current data gaps
- Execute ad-hoc requests to support both TH&N OE and other business partners
9
Experience For Quality Improvement Manager, Medicare / Hedis Resume
- Leads a team of professionals within RCC Operations and facilitates activities across matrix partner organizations
- Leads by example in technical expertise, high energy level, and can-do attitude
- Oversee day to day operations and human capital for the Central West Region’s Quality Initiatives/Medicare Senior Products
- Achieve performance metrics for the team under the triple aim model, cost containment, documentation, and Quality
- Identify process improvement opportunities within the Central West Region
- Create departmental process flows and education
- Assist with development and implementation of quality initiatives
10
Experience For Quality Improvement Manager Resume
- Collaborate with Humana leaders to share and obtain lessons learned (within the Central West and other regions)
- Provide guidance and leadership to the team and serve as a mentor for their day-to-day activities
- Works with management to create plans for improvement
- Organizes and coordinates the activities and flow of work for the assigned program
- Measures and reports program outcomes
- Promotes the program to targeted customers
List of Typical Skills For a Quality Improvement Manager Resume
1
Skills For Quality Improvement Manager Swhp Resume
- Strong computer skills including Microsoft Office platform: Word, Access, Excel, PowerPoint, Flowcharting/mapping, E-mail, Web/Internet
- Excellent analytical, verbal, written, organizational and interpersonal skills
- Excellent written and oral presentation skills, with the ability to engage, inspire, build credibility and trust
- Related progressive experience in quality systems and manufacturing; or equivalent combination of education and experience
- Proven experience with using Lean methodology and tools to partner with stakeholders to drive improvement in processes in healthcare
- Health care management experience with strong understanding of performance measurement and improvement processes
2
Skills For Quality Improvement Manager RN Resume
- Effectively train staff in QI/RM principles and practices
- Communicate effectively at all levels within the clinic and with other departments/agencies, the patients, and the public
- Effectively train staff in QI/ RM principles and practices
- Communicate effectively at all levels within Ambulatory Services and with other departments/ agencies and the public
- Demonstrated CQI and change facilitation experience (e.g., PDSA, RPI, Six Sigma, LEAN), current certification
3
Skills For Senior Laboratory & Quality Improvement Manager Resume
- IPA and/or health plan experience with a provider perspective and strong orientation to value-based care principles and the health policy landscape
- Provide leadership in identifying and adopting best practices in operating effectiveness
- Progressive experience in the health solutions industry, with emphasis on leading and managing teams (specifically nursing staff)
- Experience with NCQA. EQRO or other health plan accrediting or auditing entity
- Experience in designing improvement activities to close gaps in care and documenting performance improvement projects
- Experience with managing highly independent and dispersed staff that works out at various clinics to drive organizational improvement
- Experience managing health care related projects
- Electro-Mechanical design and manufacturing experience
- Experience in practice re-design work including Patient Centered Medical Home and Practice Transformation
4
Skills For Regional Business & Quality Improvement Manager Resume
- Experience with Practice Management Systems and Quality Improvement Projects
- Knowledge of and/or experience with Medical Terminology
- At least two-three years’ experience working in a managed care environment, preferably in a Medicaid program
- Ensure cost-effective, high-quality health care services for patients
- Efficiently operate all job related office equipment
- The ability to handle multiple projects and activities; be able to re-prioritize and quickly shift focus when needed
- Demonstrated knowledge and successful application of continuous quality improvement methods and tools
- Apply appropriate decision and prioritization tools and facilitation techniques
5
Skills For Quality Assurance & Quality Improvement Manager Resume
- Design effective process measurement and control mechanisms to leverage metrics and data for optimal business performance
- A passion for quality with demonstrated follow through and ability to set guidelines and expectations
- Clinical and/or health insurance experience
- Experience with Medicare / Medicaid regulations
- Experience with quality management
- Experience with quality management data measurement systems
- Progressive experience in quality or operations management
6
Skills For HIM Quality Improvement Manager Resume
- A valid Driver's License and ability to travel locally/regionally up to 80% of the work day
- Ensure the timely and effective identification of potential quality of care issues via
- Four (4) years of experience in Quality Improvement/Management
- Two (2) years previous supervisory or team lead experience
- Experience or background in education and facilitation
- Measures the effectiveness of operations through transaction audits
- Leadership experience in practice management, provider relations, and project management
7
Skills For European Quality Improvement Manager Resume
- Experience in quality improvement/assessment
- Experience in work site accreditation
- Experience in public health, medicaid, and/or environmental related fields
- Facilitates, manages and ensures the effectiveness of the Health Department’s Quality Improvement Committee (QIC)
- Preparing and analyzing quality data (ACO, payer, HEDIS, and CAHPS data)
- Using data to inform policy and program development
8
Skills For RN Quality Improvement Manager Resume
- Working knowledge of regulatory standards and requirements
- Understanding of health care diseases or conditions, their management, health care delivery systems and processes
- Execute global and regional quality strategy by leading projects, developing and implementing standard processes and performing training across the region
- Program management in an acute care hospital setting, including planning, implementation, evaluation, and reporting as required by laws, codes and regulations
- Support the development of training tools such as e learning and 1 to 1 / team training sessions
- Partner with RCC Operations and TH&N OE leadership in identifying, developing, and implementing quality, productivity, and cycle time improvements
9
Skills For Quality Improvement Manager, Medicare / Hedis Resume
- Develop all-inclusive training; ensuring team is well trained in areas of quality, relationship building, interpersonal communication, and change management
- Assure compliance with mandated and corporate policies regarding other departmental areas such as Provider Engagement, MRA/coding, HSO, and Finance
- Medicare Group Practice Reporting Option Web Interface (GPRO WI) or year-end ACO quality reporting
- To bring additional support to plants through the project period
- Lead and support teams that develop and implement policies, standards and systems related to improving processes
- Drive the transformation of quality improvement at Adhesives Technologies North America and Latin America North focusing on internal quality
- Intermediate level proficiency with Microsoft Office applications and data management reporting
- Proficiency with Microsoft Office applications and data management reporting
10
Skills For Quality Improvement Manager Resume
- Collaborative working style with the ability to work across different teams, areas of expertise, and adapt to ambiguous environments and clientele
- Provide both strategic and tactical leadership and direction in achieving desired business objectives with respect to quality, cost, and timeliness
- Develop future state processes and present data-based rationale for moving from current to future state process designs
- Provide constant, ongoing communication to ensure barriers/obstacles to quality/process improvement are removed and necessary support is always provided
- Maintains a positive and productive working relationship with teammates, staff, and matrix partners
- Active Registered Nursing license free of restrictions
- Establishes quality monitoring processes and tools
List of Typical Responsibilities For a Quality Improvement Manager Resume
1
Responsibilities For Quality Improvement Manager Swhp Resume
- Develops, executes, and evaluates the plan wide quality improvement (QI) program. Leads and coordinates the activities of cross-functional teams across SHP and Seton Health Alliance, and achieves progressive improvement in clinical/health outcomes, service delivery, and the experience of care
- Serves as subject matter expert on National Committee for Quality Assurance (NCQA) standards, regulatory requirements, techniques, and strategy. Designs, implements, and has oversight of the plan’s annual Healthcare Effectiveness Data and Information Set (HEDIS) data collection, analysis, and reporting efforts
- Develops quality and clinical informatics strategy, statistical analysis plans, file formats, and report/programming specifications. Analyzes complex clinical, utilization, financial, and experience data from multiple sources (including delegated vendors) and produces reports, presentations, and recommendations
- Serves as primary plan liaison with Seton Insurance Services (SIS) analytics and information technology departments, and enterprise quality and experience division. Advises SIS analytics and information technology departments on industry standards, protocols, applications, and strategy
- Reviews admissions and service requests within assigned unit for prospective, concurrent and retrospective medical necessity and/or compliance with reimbursement policy criteria
- Effectively interact with plants, development and cross functional teams to establish and maintain standards
2
Responsibilities For Quality Improvement Manager RN Resume
- Prior Medicare experience
- Four (4) years leadership experience in NCQA survey preparation
- Four (4) years managed care health plan experience in Medicaid / Medicare
- Flexibility in scheduling and ability to travel (territory covering: Fort Pierce, Sebastian and Vero Beach)
- Completes all required PHAB training
- Managed the submission for Health Plan, State, or Medicare year-end ACO quality reporting
- Lead or participate in quality improvement projects using the Six Sigma DMAIC methodology
3
Responsibilities For Senior Laboratory & Quality Improvement Manager Resume
- Perform on the job training of quality tools and methodologies
- Evaluate value and impact of both ongoing and completed conducted quality improvement projects
- Positive supervision and coaching practices
- Work cooperatively with administrators, medical personnel and nursing staff and others to obtain and evaluate information, and implement changes for QI/RM
- Maintain up-to-date knowledge of nursing practice, quality assurance trends/practices, risk management and current legislation
4
Responsibilities For Regional Business & Quality Improvement Manager Resume
- Work cooperatively with administrators, medical personnel, nursing staff and others to obtain and evaluate information, and implement changes for QI/ RM
- Provides case management and/or consultation for complex cases
- Develops and implements metrics and performance targets that assess compliance with the Missouri Department of Health and Senior Services, Centers for Disease Control and Prevention, and the Centers for Medicare/Medicaid Services regulations and best practices in public health
- Assists with audits of health department staff for compliance with policies and procedures and with regulatory and accreditation requirements
- Implements and maintains a PM and QI process that leads to a positive and measurable impact to JACOHD programs and the local public health system (LPHS)
5
Responsibilities For Quality Assurance & Quality Improvement Manager Resume
- Increase JACOHD’s capacity to evaluate and improve the effectiveness of organizational practices, partnerships, programs, uses of resources, and demonstrate the impact of these improvements on the health of the public
- Coordinate and prepare an annual report on JACOHDs PM and QI activities
- Researches PM and QI best practices and suggests areas where they could be implemented
- Meeting activities including developing agenda, facilitation, development and analysis of PM and QI data, and assisting in the design and implementation of necessary program processes and systems
- Develop and facilitate JACOHDs Accreditation team
- Maintain a document management process for demonstration of PHAB measures
- Facilitates portions of the Health Department’s Community Health Assessment (CHA) and Community Health Improvement Plan (CHIP)
- Assesses current relationships between the Health Department and community organizations, agencies and other stakeholders and develops plans to enhance and improve these relationships and partnerships
6
Responsibilities For HIM Quality Improvement Manager Resume
- Facilitate portions of the national Public Health Accreditation Board (PHAB) accreditation process
- Maintains and upgrades professional knowledge, skills and development by attending seminars and training programs and reading trade and professional journals and publications
- Participates in JACOHD strategic planning process
- Assists in the development and coordination of community and agency partnerships, initiatives, programs and events to address identified community health priorities and improve population health; develop and implement processes to ensure public improvement and input
- Utilizes appropriate methods for interacting effectively and professionally with persons of all ages and from diverse cultural, socioeconomic, educational, racial, ethnic, sexual orientations, lifestyles and physical abilities
- Promotes quality improvement, staff and patient safety, and cultural diversity through department operations and by personal performance
- Presents a courteous and helpful demeanor, appropriate for ages, to all patients, visitors, other TMC employees/medical staff members, or any other person an employee encounters while representing TMC
- Provides expert writing for the content of the Medicaid Quality Strategy. Also provides project management support for the planning, reviewing, and public comment process for the update of the Medicaid Quality Strategy. Provides support for the ongoing monitoring and evaluation of the Medicaid Quality Strategy
7
Responsibilities For European Quality Improvement Manager Resume
- Monitors managed care plans’ performance on access, clinical quality, patient experience, and care management indicators
- Provides support in the analysis of the managed care Performance Goal Program and the calculation of performance awards
- Gives technical support to the aggregation of data, submission, and analysis of Centers for Medicare and Medicaid Services (CMS) Adult and Child Core measure sets
- Coordinates the annual external quality review activities between the managed care plans and the External Quality Review Organization (EQRO). Provides support for the review and submission of the annual technical report to CMS
- Analytic skills- the ability to interpret and synthesize quantitative and qualitative data
8
Responsibilities For RN Quality Improvement Manager Resume
- Provides project management support for the procurement of a new contract for the EQRO
- Manages all quality committees under the UnitedHealthcare Community Plan umbrella to assure that QM Committee activities are fulfilled and recorded
- Serves as a liaison with national quality committees to communicate back information to the local plan as needed
- Assures that quality management documents the Quality Management Program Description, the annual Quality Improvement Work Plan and the annual Quality Management Program
- Evaluations are written and updated as required to fulfill requirements of UHC national QMP, NCQA and State regulations
- Manages all existing QMP policy & procedures, writes new QMP policy & procedures and matches policy and procedure to regulatory requirement and accreditation crosswalk, and ongoing regulatory and accreditation readiness
- Provide project management oversight for all activities associated with HEDIS, CAHPS, PIPs, PMs and TMs
- Conducts performance improvement projects and complete submission of necessary reports
9
Responsibilities For Quality Improvement Manager, Medicare / Hedis Resume
- Serves as the QMP manager for quality related audits (i.e. EQRO, HEDIS, etc.) and assures that all QMP requirements under the audit are met
- Manages quality related reports as required by State, NCQA, etc
- Evaluates Managed Care plans’ and the Accountable Entities’ performance in achieving specific access, quality, health outcome, customer service and other key performance indicators
- Provides support to the creation and ongoing operation of the State’s Integrated Health Homes
- Provides technical assistance on quality metrics for the State’s Health Services Transformation Program, a multiyear Medicaid initiative to achieve meaningful payment reform, along with key healthcare workforce development objectives
- Oversees the work of the Compliance liaison to Medicaid’s Office of Program Integrity, who also facilitates coordination of all program integrity activities between EOHHS and the MCOs
- Assesses QI/RM needs and trends for the Santa Clara Valley Health Services program by reviewing current practices, and gathering, compiling and evaluating data related to employees, services, problems reported, and patient feedback
- Assists in planning, preparing, and compiling reports for federal and state regulatory agencies and JCAHO
10
Responsibilities For Quality Improvement Manager Resume
- Participates in continuing education activities for professional growth, licensure and certification requirements
- Directs the development, coordination and evaluation of the Disease Management Services in the Ambulatory & Community Health care setting
- Oversees preparation for Santa Clara Valley Medical Center Accreditation Survey
- Oversees, promotes, and assists in monitoring compliance with federal, state and Joint Commission on Accreditation of Health Care Organizations (JCAHO) standards
- Plans/executes programs designed to enhance physician, nursing and support staff knowledge of quality improvement and risk management
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