Director, Quality Management
Posted on: June 15, 2019
Job Brief Director, Quality Management - RN Your career starts now.
We're looking for the next generation of health care leaders. At
AmeriHealth Caritas, we're passionate about helping people get
care, stay well and build healthy communities. As one of the
nation's leaders in health care solutions, we offer our associates
the opportunity to impact the lives of millions of people through
our national footprint of products, services and award-winning
programs. AmeriHealth Caritas is seeking talented, passionate
individuals to join our team. Together we can build healthier
communities. If you want to make a difference, we'd like to hear
from you. Headquartered in Philadelphia, AmeriHealth Caritas is a
mission-driven organization with more than 30 years of experience.
We deliver comprehensive, outcomes-driven care to those who need it
most. We offer integrated managed care products, pharmaceutical
benefit management and specialty pharmacy services, behavioral
health services, and other administrative services. Discover more
about us at . AmeriHealth Caritas North Carolina has been awarded a
contract to provide a standard benefit plan under the state's new
Medicaid managed care program, which will also include long-term
services and supports. The program will be launched in two phases -
the first on Nov. 1, 2019, and the second on Feb. 1, 2020. The
Director, Quality Management is responsible and accountable for the
successful, ongoing development, refinement, implementation,
measurement, ongoing quality improvement and effectiveness of the
Health Plan's, Line of Business, or Product's Quality Management
Program. Additionally, the position is responsible and accountable
for QAPI program activities and for the ongoing maintenance of the
Plan's compliance with state regulations and NCQA/URAC and other
appropriate standards for activities related to Quality, Care
Management and Utilization Management. This includes
credentialing/re-credentialing activity, delegation oversight,
quality of care investigations as well as the corresponding inter-
and intra-departmental coordination, communication, and education.
- Works directly with Senior Executives to plan, organize and
direct the identification, prioritization and implementation of
strategic projects that improve financial, service and clinical
outcomes for the Plan, LOB or Product Line.
- Meets with DHHS and the other MCO's to review quality related
initiatives and how those initiatives can be coordinated across the
- Provides primary oversight and responsibility for the Plan's,
Line of Business or Product Line's Quality and Medical Management
Committee structure and support.
- Provides functional support to the Network Management,
Informatics, Information Solutions, Care Coordination, Utilization
Management, and Public Affairs departments to integrate Quality
Management initiatives and goals with organizational programs.
- Plays an active role in the dissemination of the Quality
Management best practices throughout the AmeriHealth Caritas Family
of Companies and assists with new business opportunities and
implementation. Education and Experience:
- Bachelors degree required, Masters preferred
- 5+ years managed care experience preferred
- 5+ year's managerial experience.
- 8-10 years of progressively responsible healthcare or clinical
experience in a quality management related role
- Prior URAC or NCQA Accreditation experience
- Must reside in North Carolina per contractual
- An unrestricted certified license (LCSW, RN, MD, DO) in North
Carolina is required based on contractual requirements. #SP1 Back
Keywords: Amerihealth, Raleigh , Director, Quality Management, Executive , Raleigh, North Carolina
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