CalOptima · 7 hours ago
Program Manager, Quality Improvement
United States
Full-time
Remote
Mid Level
$78K/yr - $125K/yr
3+ years expCalOptima is a mission-driven community-based organization focused on member health. The Program Manager for Quality Improvement will oversee accreditation processes and ensure compliance with health care regulations while collaborating with various stakeholders to enhance healthcare quality and equity.
GovernmentHealth CareNon Profit
Responsibilities
Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability
Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department
Leads CalOptima Health through the NCQA Health Plan and Health Equity accreditation process and renewals for all applicable products and provides leadership to all business areas to ensure standards are known and met
Leads and facilitates NCQA regulatory audits and audit readiness activities for the department
Stays current on NCQA accreditation standards as well as local, state and federal health care environment; identifies issues and communicates areas that may impact CalOptima Health's QI programs
Ensures all NCQA related policies are reviewed and updated to meet NCQA and regulatory compliance annually; works directly with regulatory and compliance to ensure submissions are reviewed timely and with legal review
Assists in the development and bookmarking of documents used for NCQA accreditations and other regulatory agency reporting submissions
Engages and collaborates with all external NCQA and regulatory related vendors and organizations, including but not limited to NCQA and NCQA consultants, to ensure standards are known and met and accreditation surveys are submitted accurately and timely
Initiates and maintains contact with key business owners to ensure proper submission of required documentation for the accreditation and renewal survey and regulatory audits
Assists the manager and director in developing annual regulatory compliant QIHETP documents, including the QIHETP description, annual workplan and evaluation
Monitors quality improvement actions and activities across the organization to ensure the QIHETP description and annual work plan are executed as planned and meet regulatory requirements
Manages policies for the department and collaborates with the appropriate business owners to update policies as needed to maintain compliance with NCQA, DHCS, DMHC, CMS, and other regulatory requirements
Represents QI at various CalOptima Health committee meetings such as the Quality Improvement Health Equity Committee (QIHEC) and its related subcommittees or workgroups
Designs and develops process improvements for the department to support and ensure NCQA and regulatory compliance
Engages and collaborates with both internal and external audit and oversight departments to ensure that NCQA standards and quality requirements are met
Manages the accurate and timely submission of regulatory filings and reporting requirements on an ongoing basis
Works with all CalOptima Health departments in response to inquiries, problem-solving and promoting CalOptima Health's mission and message
Researches national, state and local health policy issues that may impact CalOptima Health's mission, vision and strategic goals
Supports the manager in preparing and facilitating the NCQA Steering Committee meeting
Represents the department in various internal and external meetings
Provides program support to managers and other team members, assuring PQI, credentialing, FSR and PARS processes are compliant with regulatory or audit and accreditation requirements
Manages and facilitates file review audits with internal staff and delegated networks
Completes other projects and duties as assigned
Qualification
Required
Bachelor's degree in health care or related field PLUS 3 years of experience working with health care delivery systems and/or in a public agency serving the related population; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying
3 years of experience in program and/or project management
2 years of experience within managed care or quality management
Preferred
2 years of experience with outreach and public speaking or public relations
2 years of experience successfully managing and achieving NCQA accreditation for a health plan or equivalent
1 year of experience and aptitude for working in a highly matrixed, mission-driven organization
Benefits
Comprehensive benefits package
CalPERS pension program and additional retirement packages
Generous PTO program
Quality work life balance
Various wellness programs
Tuition Reimbursement
Professional development opportunities
Career development opportunities
Flexible scheduling
Satisfaction of knowing your work directly impacts and improves healthcare access for thousands of individuals and families
Company
CalOptima
CalOptima is a county organized health system that provides health insurance programs.
1001-5000 employees
Funding
Current Stage
Late StageLeadership Team
Greg Hamblin
Chief Financial Officer
Brigette Hoey
Chief Human Resources Officer
Recent News
Orange County Register
2023-06-21
Orange County Register
2023-05-19
Orange County Register
2023-05-17
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