Quality Manager in Depew, NY
Family Choice of New York Posted: 2023-09-19
Depew, NY 14043
Salary Range: Salary: $90,000.00 - $94,000.00 per yearFamily Choice Of New York is seeking an experienced RN with Quality Management experience.
The Quality Manager is responsible for leading, managing and executing quality programs for the organization.
This position has a unique quality focused role that mixes both clinical case-by-case quality assessment and plan type program quality requirements that tie to care management and overall performance.
It requires a critically thinking RN who is proactive in looking for opportunities to improve care as well as assure compliance with state, federal, and health plan laws and regulations and is accountable for successful quality audits conducted by health plan and regulatory bodies.
o Oversees the Quality Department and manages quality improvement activities to ensure overall quality and compliance for all FCNY programs (MOC requirements, professional standards, state and federal regulatory requirements).
o Oversees Satisfaction Survey process and PCP Quality Incentive Bonus process in collaboration with Sales and Network Manager.
o Responsible for the QM program goals and requirements.
o Responsible to attend facility operations meetings to represent clinical operations and quality.
o Oversight of the reviews for hospitalization, critically analyze data, and provide feedback to staff as needed.
o Review data to detect outliers, trends, and unusual patterns of utilization and provide recommendations to the QM committee and management team.
o Collaborates with clinical team of all programs to execute the implementation of the clinical quality data initiatives.
o Maintains QI program documents, reports, and committee minutes and follows all internal privacy and confidentiality policies and procedures.
o Oversees and maintains current knowledge of regulatory requirements associated with the QI programs and initiatives (i.e. HEDIS, CCIP, etc.)
o Leads the development, implementation, monitoring, and analysis of FCNY’s Quality Improvement Program strategy.
o Assist with monitoring service of delivery and outcomes to ensure services are not over-utilized or under-utilized.
o Develops QM work plan, QAPI, Performance Improvement Projects, and other quality management projects as required.
o Drives key quality improvement projects requiring the ability to work effectively with the team in order to receive/evaluate needed data that reflects the overall health of the plan.
o Develops and maintains Quality and MOC policies that support the company initiatives that meet State, Federal, and legal requirements and standards.
o Performs quality reviews on all record requests.
o Develops MOC, QAPI, Performance Improvement Projects, and other quality management projects as required.
o Responsible for Model of Care quality accountability.
o Monitors, tracks, and reports on performance against MOC or other metrics.
o Oversees the fulfillment of any Corrective Actions with respect to MOC or QM.
o Leads QM Committee meetings, coordinates committees and sub committees where appropriate to achieve health plan and company quality goals.
o Participates in a presenter role as directed in various evaluations and audits.
o Oversees ongoing Care Management case reviews across programs and identifies opportunities for education, counseling, and ensures any feedback is shared with staff members.
o Attends regular and “trouble shooting” operations meetings in facilities.
o Attends executive team meetings.
o Oversees RN coordinators to ensure compliance with CMS regulations with respect to care coordination.
o Other duties as assigned.
• Determine staffing requirements.
• Recruit, hire and onboard/train new staff.
• Supervise direct reporting staff according to overall company policy.
• Set employee goals and objectives.
• Monitor and conduct performance evaluations of staff at the end of the 90-day introductory period, at established development plan dates and at annual anniversary dates for own direct reports.
• Delegate work duties to staff to attain objectives.
• Provide coaching, disciplinary/corrective action as necessary up to termination.
• Develop staff to maximize potential.
• Develop department procedures.
• Apply strategic planning to determine company, department or unit objectives.
• Collaborate with and contribute to the Leadership Team.
· Strong leadership and communication skills.
· Demonstrate ability to supervise staff and work collaboratively with all levels of staff and management.
· Excellent analytic skills.
· Must be able to assess findings and data to make recommendations for program performance and effectively present both the findings and the supporting arguments for any recommendations. This position is expected to play a leadership role within the organization in collaboration with other members of the leadership team.
· Must support company decisions, direction, and work to achieve company goals.
· Must be able to build and maintain collaborative, cooperative, and productive relationships with all internal and external customers including members and their families, nursing facility staff, physicians, the health plan, and any other stake holders in the community.
· Must be goal oriented with a strong sense of personal initiative and accountability to achieve performance targets.
· Ability to effectively communicate with senior management and direct reports staff as to necessary actions.
· Ability to analyze data and business intelligence to identify, develop, and implement appropriate actions.
· Strong problem-solving skills.
· Ability to work both independently and collegially.
· Able to both effectively delegate and maintain oversight while also being an active contributor to final work product.
· CPR certification
· Valid NYS Driver’s License and maintain automobile insurance per company requirements
Job Type: Full-time
Salary: $90,000.00 - $94,000.00 per year
• 401(k) matching
• Dental insurance
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Referral program
• Vision insurance
• 8 hour shift
Supplemental pay types:
• Bonus opportunities
• Quality Management: 1 year (Required)
• Valid NYS Registered Nurse License
• Project Management Certification (Preferred)
Please fax resume to 716-558-0279
Please apply with resume via Quick Apply
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All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, gender identity or expression, age, or national origin.