Apply on Employer Site

CareSource · 3 hours ago

REMOTE - Manager, Market Quality Improvement - Must Reside in Georgia - R11080-1

United States

Full-time

Remote

Mid, Senior Level

$83K/yr - $133K/yr

3+ years exp

CareSource is a healthcare organization, and they are seeking a Manager for Market Quality Improvement. The Manager will oversee quality improvement projects, ensure compliance with regulations, and foster collaboration across departments to enhance healthcare quality in the assigned market.

Health CareMedicalNon Profit

Comp. & Benefits

H1B Sponsor Likely

Hiring Manager

Jennifer McCune

Responsibilities

Responsible for Corporate oversight of the HEDIS Medical Record Review Unit as needed for the assigned market

Responsible for development and oversight of Quality Improvement (QI) Projects and Performance Improvement Projects related to HEDIS and pay for performance (P4P) requirements

Ensures compliance with External Quality Review audits/studies, Performance Improvement Projects, and Quality Improvement Projects required by the state, NCQA, and other accreditation bodies

Responsible for the review of QI issues regarding compliance with Federal, State, and Accreditation requirements

Ensure all policies and procedures are aligned with Federal, State, and Accreditation requirements

Responsible for the annual review, program description, program plan, and update of QI Department policies and procedures

Provide education to internal and external customers on quality improvement functions

Respond to questions that pertain to HEDIS and Quality Improvement from providers and internal staff members

Foster relationships with all internal departments and represents CareSource to community-based and state programs

Collaborate with business owners to establish, implement, and develop best practices for P4P quality directives

Implement opportunities for process improvement that impact quality measurements in assigned market

Monitor industry trends as it relates to healthcare and identify areas of opportunity for improvement

Responsible for ensuring business owners successfully complete all deliverables related to performance improvement plans (PIPs) and quality improvement plans (QIPs) within defined timeframes

Conducts analysis, including root cause analyses with support from identified business units and ensure data is presented and used efficiently to meet the quality goals

Follows enterprise standards and procedures for all quality reporting and documentation and communicate areas of strengths as well as needs to the Quality Improvement Committee

Perform all facets of quality management to include the development of detail work plans, setting deadlines, assigning responsibilities and monitoring/summarizing project progress

Establish, monitor and review mechanisms to assess and document each business units level of compliance with each measure and coordinate corrective actions

Attends and participates in market quality committees

Guide and direct successful completion of daily tasks and projects

Interview, select and train new team members

Conduct performance management activities for direct reports, to include monthly one-on-one meetings, annual performance appraisals, and discipline as appropriate

Perform any other job related instructions, as requested

Qualification

Quality Improvement ProjectsHEDIS ComplianceData AnalysisHealthcare ExperienceMicrosoft OfficeLeadership SkillsCustomer ServiceTraining SkillsCommunication SkillsTime ManagementProblem Solving

Required

Bachelor's Degree or equivalent years of relevant work experience

A minimum of three (3) years of experience in a healthcare or managed care organization

Previous management experience

Intermediate proficiency in Microsoft Word, Excel and PowerPoint

Solid leadership skills; able to effectively manage a high performing team, provide coaching and development

Demonstrated ability to adjust and shift priorities, multi-task, work under pressure and meet deadlines

Proven ability to recognize opportunity for improvement and lead change

Data analysis and trending skills

Effective communication skills

Prior supervisory skills

Ability to work independently & in a team environment

Training/teaching skills

Time management skills

Critical listening and thinking skills

Strategic management skills

Decision making/problem solving skills

Customer service oriented

Preferred

Completion of an accredited Registered Nursing degree program or Bachelor's of Science in Nursing (BSN)

Master's Degree in Nursing (MSN), Public Health, or healthcare related field

Medicaid and/or Medicare experience

Experience in quality metrics

Current, unrestricted Registered Nurse (RN) licensure in the state of practice

Certified Professional in Healthcare Quality (CPHG)

Benefits

You may qualify for a bonus tied to company and individual performance

Substantial and comprehensive total rewards package

Company

CareSource

Glassdoor3.8

CareSource provides managed care services to Medicaid beneficiaries.

Founded in 1989

Dayton, Ohio, USA

1001-5000 employees

https://www.caresource.com/

H1B Sponsorship

CareSource has a track record of offering H1B sponsorships. Please note that this does not guarantee sponsorship for this specific role. Below presents additional info for your reference. (Data Powered by US Department of Labor)

Distribution of Different Job Fields Receiving Sponsorship

Represents job field similar to this job

Trends of Total Sponsorships

2025 (30)

2024 (39)

2023 (35)

2022 (21)

2021 (37)

2020 (28)