Quality Program Development Manager

This is a fully remote position, open to applicants in Illinois, +1 more state.

📋 Description

• Collaborate with Quality, Health Services, and Operations business leaders or cross-functional teams to create and execute standards, policies, procedures, workflows, and decision support systems.

• Supervise the establishment and execution of programs that support strategic initiatives in Health Services, clinical quality, and operational quality management.

• Design and facilitate programs, systems, workflows, and integration efforts that comply with corporate, market, contractual, regulatory, and quality standards.

• Act as a content and technical subject matter expert for operations managers and directors.

• Create comprehensive work plans, lead root cause analysis, identify and promote process improvements, set deadlines, assign responsibilities, and track and summarize project progress.

• Lead state-mandated Performance Improvement Projects (PIPs), encompassing topic selection, root cause analysis, implementation, and final submission.

• Perform needs assessments and ensure program teams and external stakeholders receive timely information.

• Collaborate with Quality Analytics and Improvement Teams to identify data requirements and assist in the development of tools and reports.

• Provide analysis services for patient quality-of-care improvement initiatives by consulting with clinical and operations staff.

• Undertake additional responsibilities and duties as assigned.

• Adhere to all policies and standards.

⛳️ Requirements

• A Bachelor's Degree in a relevant field is required.

• Equivalent work experience in Business, Healthcare Management, or Nursing will be considered.

• At least 5 years of experience in direct program development, program management, and/or project management, ideally within a healthcare setting.

• A minimum of 3 years of experience in managed care, including utilization management, care coordination, disease management, Medicare, Medicaid, DSNP, dual eligibles, and PCMH.

• Over 2 years of experience in designing, developing, and implementing STARS, CAHPS, HEDIS, and other quality-related programs across the enterprise.

• Experience in defining eligible populations, service mix, delivery system configuration, and financing.

• Proficiency in integrating behavioral, clinical, social, and community healthcare for members with multiple chronic conditions.

• Experience collaborating with multiple market leaders to coordinate consistent quality initiatives.

• Proven experience in conducting assessments, contractual reviews, and business plans for new quality improvement programs.

• Skilled in integrating innovative strategies into defined programs to enhance quality ratings across the company.

• Six Sigma Certification, Lean Certification, or Certified Professional in Healthcare Quality (CPHQ) is preferred.

🏝️ Benefits

• Competitive pay.

• Health insurance.

• 401K.

• Stock purchase plans.

• Tuition reimbursement.

• Paid time off plus holidays.

• Flexible work arrangements, including remote, hybrid, field, or office schedules.