Henry Ford Health · 11 hours ago
Manager Quality - Value Based Care (Hybrid Detroit/Jackson) - Mosaic CIN
Detroit, MI
Full-time
Hybrid
Mid, Senior Level
5+ years expHenry Ford Health is seeking a Quality Manager responsible for overseeing quality programs and interventions related to Medicaid and Medicare. This role involves ensuring compliance with regulatory standards and managing the quality management initiatives to improve healthcare quality outcomes.
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Responsibilities
Responsible for the development, implementation, and management of Quality Management (QM) programs and initiatives within the health plan; establishes QM objectives, policies and procedures, and annual goals based on prior year performance evaluation
Ensure efforts to fulfill regulatory standards including NCQA and compliance for the MDHHS and CMS reporting; ensures timelines of standards for submission are met
Provides training and education to key plan leaders and staff to meet NCQA standards and MDHHS compliance; assure readiness and appropriate communication related to surveys and site visits
Manages the activities of the department to support the quality management program and interventions
Establishes strategic plans; oversees policies and procedures and clinical practice guidelines at all levels and with all critical operation departments to ensure quality programs are consistent with overall quality strategies
Coordinate and conduct annual reviews of high volume PCP’s in the areas of Appointment Wait Times and After Hours Access to Care
Responsible for all federal and state reporting requirements for the Medicare programs. Ensures timely and accurate reporting into HPMS for quarterly, semi-annual and annual reporting to CMS for part C and Part D reporting requirements
Coordinates development, implementation, and evaluation of continuous quality management action plans for the activities specific to CAHPS, HOS, state based performance programs, CMS reporting requirements, External Quality Review Organizations (EQRO) or other audit or annual evaluation findings
Monitor member complaints to identify potential quality of care and/or provider site issues that require a credentialing site visits or follow-up action plan
Works in conjunction with leadership team to ensure strategies for attaining a 3.5 star rating or better are successfully implemented for the Medicare products
Works with HAP departments to ensure all CAHPS and HOS activities are accomplished timely and accurately
Organize the plan quality management committee (QMC); responsible for meeting preparation, notice, agenda, materials and minutes
Partake in professional work groups, as assigned, including but not limited to the Michigan Association of Health Plans (MAHP), the Michigan Quality Improvement Consortium (MQIC), MDHHS initiatives, health plan initiatives, State and local committees, etc
Other quality management activities, as directed by the Director of Outreach, DM, Quality
This position will be focused on Centers for Medicare & Medicaid programs to support ACOs
Qualification
Required
Bachelor's Degree in health administration, health promotion, public health, nursing, or other related field
Minimum of five (5) years of experience in the healthcare industry. One (1) year quality improvement experience
Manage quality work and enforce quality healthcare throughout the organization
Identify barriers to quality healthcare and/or gaps in process that interfere with the delivery of quality healthcare
Demonstrate strength in teaming and interpersonal skills and the ability to initiate and maintain cross-team relationships
Meet mission/critical deadlines and to motivate staff to meet these deadlines
Manage projects, people and time resources and monitor the effectiveness of activities
Organizational skills
Multiple healthcare knowledge areas; including clinical, coding, business operations, and IT analytics
Appreciation of cultural diversity and sensitivity towards target population
Excellent verbal and written communication skills
Computer literacy (including the ability to navigate through internal and external systems)
Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPPA)
Preferred
Master's degree in health related field
Managed care organizations, Medicaid and/or Medicare
Prior leadership/management position
Familiarity with value based care and quality measures
Experience in performance improvement activities to ensure maximum quality scores
CPHQ
Knowledge of HEDIS, CAHPS, and NCQA accreditation
Company
Henry Ford Health
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10001+ employees
H1B Sponsorship
Henry Ford Health 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 (212)
2024 (156)
2023 (134)
2022 (159)
2021 (140)
2020 (153)
Funding
Current Stage
Late StageTotal Funding
$40.27MKey Investors
Mort Harris
2020-06-04Grant· $0.27M
2018-04-09Grant· $20M
2016-12-05Grant· $20M
Leadership Team
Robert Riney
President and CEO
Recent News
2025-11-07
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