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Medicaid Director of Quality Improvement - Texas - (17006772)

  • Location: Bedford, TX
  • Salary:
  • Posted: Oct 5

Click here to view a full job description and apply if qualified!

Required: Located in Texas (Work from home opportunity available)
Preferred: Located in the Dallas / Fort Worth Metroplex area
Individual will be required to attend state meetings in Austin, TX
The Medicaid Director of Quality Improvement will oversee all Quality Improvement functions for the health plan. The Director will lead and direct staff and process improvement activities for more efficient and streamlined workflow to meet regulatory requirements and improve the health, well-being and sense of security of plan members. The position provides the opportunity to interact with other plan leaders as well as state and federal regulators.
Responsible for measurement, reporting, analysis and trending of quality data; creation and presentation of reports and summaries related to performance on metrics such as HEDIS, PPE, PQI measures
Responsible for activities related to quality metrics performance including: providing Medicaid subject matter expertise to the Shared Services HEDIS team; interfacing with state Medicaid and External Quality Review Organization stakeholders on metrics selection and reporting
Managing measurement and projections related to various premium at risk and P4Q programs that incorporate HEDIS, PPE, PQI metrics. Organize and control activities, methods, and procedures to achieve timely, accurate reporting on quality metrics
Manage quality initiatives dedicated to reducing admissions, readmissions and ER visits
Manage quality initiatives related to NCQA accreditation activities
Interface with multiple internal stakeholders to deploy quality initiatives
Development and implementation of a provider incentive program including outreach, incentives, data integrity, chart review and reporting
Responsible for the development and deployment of state and federal performance improvement projects (PIPs/QIPs) and the data gathering and reporting requirements related to those projects
Responsible for managing Quality of Care Clinical Review nurses in activities related to the investigation and closure of quality incidents and allegations of abuse, neglect or exploitation
Present results of improvement efforts and ongoing performance measures and recommend action
plans to senior management
Research and incorporate quality improvement best practices into operations
Interface with Shared Services team related to the adoption, update and approval submission activities for clinical practice guidelines 
Formulate and establish policies, operating procedures, and goals in compliance with internal and
external guidelines

Click here to view a full job description and apply if qualified!

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