Manager – Healthcare Quality, Project Management

This is a fully remote position, open to applicants in Louisiana.

📋 Description

• Oversee behavioral health population health initiatives for members of Louisiana Medicaid

• Perform behavioral health population health assessments to determine priority groups, identify disparities, recognize gaps in care, analyze social determinants of health, utilization trends, and pinpoint areas for improvement

• Evaluate claims, quality performance, utilization data, member and provider feedback, community statistics, and indicators related to population health

• Create, execute, and assess the behavioral health elements of the annual Population Health Management Strategy

• Formulate strategic recommendations that address access, engagement, care coordination, quality outcomes, health equity, and the integration of behavioral health

• Direct comprehensive Behavioral Health Performance Improvement Projects, encompassing design, execution, monitoring, evaluation, and reporting

• Maintain project documentation including plans, timelines, risk and decision logs, evidence repositories, submission calendars, and reporting materials

• Organize quarterly, annual, and ad hoc Performance Improvement Project (PIP) reporting and regulatory submissions

• Track quality measures for behavioral health including Follow-Up After Hospitalization (FUH), Follow-Up After Mental Health (FUM), Follow-Up After Substance Use (FUA), HEDIS, and state and organizational metrics

• Conduct root cause analyses, barrier analyses, and assessments of performance gaps

• Prepare dashboards, scorecards, executive summaries, presentations, and reports

• Communicate findings to leadership, quality committees, provider groups, state stakeholders, and various audiences

• Create educational resources for providers, member outreach initiatives, and engagement strategies

• Collaborate with community organizations, advocacy groups, healthcare providers, and vendor partners

• Incorporate health equity and social determinants of health into assessments and interventions

• Uphold Louisiana Medicaid, regulatory, accreditation, NCQA, HIPAA, and organizational quality standards

• Ensure documentation is audit-ready and assist with governance, committee, and strategic planning efforts

⛳️ Requirements

• Bachelor’s degree in Public Health, Population Health, Healthcare Administration, Behavioral Health, Psychology, Counseling, Social Work, Nursing, Health Sciences, Business Administration, Project Management, or a related discipline

• Minimum of three years’ experience in Healthcare Quality, Population Health, Behavioral Health, Medicaid Managed Care, Quality Improvement, Program Management, Project Management, or a similar healthcare area

• Proven experience in leading intricate cross-functional projects that involve multiple stakeholders

• Proficient in analyzing healthcare quality, utilization, population health, or clinical performance data

• Background in developing and implementing quality improvement or population health initiatives

• Skilled in preparing presentations, reports, and recommendations tailored for leadership audiences

• Management of Performance Improvement Projects (PIP)

• Knowledge of Quality Improvement Methodologies

• Competence in Data Analysis and Performance Monitoring

• Strong Project Management abilities

• Experience in Root Cause and Barrier Analysis

• Effective Provider and Stakeholder Engagement skills

• Expertise in Executive Communication and Presentation

• Ability to collaborate across functions

• Strategic Planning and Execution capabilities

• Proficiency with Microsoft Office Suite and collaboration platforms

🏝️ Benefits

• CVS Health bonus, commission, or short-term incentive program in addition to base salary

• Medical insurance coverage

• Dental insurance coverage

• Vision insurance coverage

• Paid time off

• Retirement savings options

• Wellness programs

• Additional resources for supporting physical, emotional, and financial well-being