Director, System Quality Assurance
Posted on: 7 Feb 2021
Oklahoma City, Oklahoma
Job Description
Position Purpose:
Lead and direct process improvement activities that provide more efficient and streamlined workflow.
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* Responsible for leading and collaborating with others on National Committee for Quality Assurance (NCQA) Accreditation and/or Healthcare Effectiveness Data and Information Set (HEDIS) performance
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* Responsible for quality improvement aspects of risk adjustment processes for all products
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* Collaborate with Medicare STARS team to improve overall STARS ratings for Medicare products (including HEDIS, CAHPS, HOS)
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* Oversee provider satisfaction surveys and implement action plans for improvements
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* Research and incorporate best practices into operations
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* Organize and control activities, methods, and procedures to achieve business objectives
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* Review and implement new technological tools and processes and fosters team concept with internal and external constituencies
tPresent results of improvement efforts and ongoing performance measures to senior management
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* Formulate and establish policies, operating procedures, and goals in compliance with internal and external guidelines
Bachelor's degree in Nursing, related clinical degree or equivalent experience. 7+ years of quality management, quality improvement or healthcare operations experience. Masters' degree preferred.
License/Certificates: Certain states may require a formal certification in quality improvement, risk management, or another parallel field. Current state's RN license preferred. Certified Professional in Health Care Quality preferred.
title:Director, System Quality Assurance
WellCare
Tampa, FL
WellCare Health Plans, Inc. provides government-sponsored managed care services. The company operates in three segments: Medicaid Health Plans, Medicare Health Plans, and Medicare Prescription Drug Plans (PDPs). The Medicaid Health Plans segment offers plans for beneficiaries of temporary assistance for needy families, supplemental security income, and aged blind and disabled residents; and other state-based programs, such as children's health insurance programs and long-term services and supports programs for qualifying families who are not eligible for Medicaid.
The Medicare Health Plans segment provides Medicare, a federal program that provides eligible persons aged 65 and over, as well as some disabled persons with a range of hospital, medical, and prescription drug benefits; Medicare Advantage, a Medicare’s managed care alternative to the original Medicare program, which offers individuals standard Medicare benefits directly through Centers for Medicare & Medicaid Services; and coordinated care plans that are administered through health maintenance organizations and require members to seek health care services and select a primary care physician from a network of health care providers.
The Medicare PDPs segment provides Medicare part D PDP plans to Medicare-eligible beneficiaries. Its PDP plans offer national in-network prescription drug coverage, including a preferred pharmacy network. As of December 31, 2018, the company served approximately 5.5 million members in the United States. WellCare Health Plans, Inc. was founded in 1985 and is headquartered in Tampa, Florida.
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IndustryHealthcare
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No. of Employees12, 000
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Website
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Jobs Posted917
