Director, Quality and Care Management
REQUEST FOR REFERRAL
Lee Calhoon & Co.,
a healthcare executive search firm, has been retained to evaluate
candidates for the
position of Director,
Quality and Care Management. The position reports to the Chief
Medical Officer and is located in Chicago, Illinois. It offers
an excellent compensation and benefits package.
Position
Summary:
This position
is responsible for developing and implementing a quality improvement
and utilization management
program that is consistent with the philosophy of the health
plan. Leads, coordinates and ensures documentation of all accreditation
and state performance activities for the health plan. Develops
and implements a comprehensive corporate strategy to ensure
HEDIS and CAHPS improvement. Oversees the utilization management,
case
management and disease management programs. Responsible for
ensuring that all programs are compliant with National Committee
for Quality
Assurance (NCQA) standards as well as state and federal regulatory
requirements.
Essential Functions:
-
Oversee the development, implementation
and annual evaluation of the corporate Quality Improvement
Plan and Care
Management Program.
- Monitor
and ensure compliance with all state regulatory requirements,
including the state performance measures.
-
Serve
as the leader for HEDIS and CAHPS reporting and improvement
activities.
-
Lead
and direct the organization’s
NCQA accreditation survey preparation for managed care
organizations and provide
support for all department directors and managers to ensure
that the compliance requirements are met for each area.
-
Ensure
that the utilization management process is well organized,
efficient, clinically appropriate
and meets all of
the regulatory requirements, including NCQA standards.
-
Develop
systems and processes for prospective, concurrent and
retrospective utilization review that are based
upon medical
necessity guidelines, clinical protocols and recognized
standards of care.
-
Collect,
analyze and maintain data regarding utilization of
medical services.
-
Oversee
the identification, tracking, resolution and response
to all denials and appeals in compliance
with NCQA standards.
-
Oversee
the development and implementation of Case Management
and Disease Management programs for enrollees
identified
as a priority within the health plan membership.
-
Ensure
that appropriate policies and procedures are in place
to support all care management, quality
improvement
and disease management activities.
-
Oversee
the Quality Improvement Committee structure and participate
in committee meetings as appropriate.
-
Promote
a provider-friendly, customer service oriented philosophy
within the Quality Improvement
and Care Management
departments.
-
Identify
and implement opportunities to enhance efficiency through
the use of the MCS system as
well as departmental process
improvements.
-
Develop and monitor the budget for quality
improvement and care management activities and ensure that
sufficient resources
are assigned to meet department goals.
-
Prepare
monthly and quarterly reports for submission to the
leadership team and the Board of Directors.
-
Serve
as a liaison for the health plan concerning quality
and care management activities, including
participation in external
meetings and coordination with external entities.
-
Maintain
strict confidentiality of employee and organizational
information in accordance with HIPAA and
State privacy regulations.
Job
Requirements:
Education:
-
Bachelor’s
degree in nursing.
-
Current
Illinois license as a Registered Nurse or license eligibility
required.
-
Masters
degree in nursing, health care administration or related
field preferred.
Experience:
-
Three
to five years of experience in quality improvement and utilization
management.
-
Previous experience with case management
and disease management preferred.
-
Previous experience in managed care
and Medicaid programs.
-
Prior successful completion of an NCQA
accreditation survey for managed care.
-
·Previous
management and supervisory experience.
-
·Knowledge
of the National Committee on Quality Assurance (NCQA) standards
for managed care organizations.
-
·Knowledge
of HEDIS and CAHPS reporting processes.
-
·Knowledge
of health care utilization management processes and
documentation.
-
Knowledge of authorizations, medical
records and claims data.
We welcome sharing additional information about this engagement
with you personally, and would appreciate any referrals of colleagues
who may have the credentials we are seeking. For additional information
contact: Bill Fedora, Principal at 610-469-9053 or email at wfedora@leecalhoon.com.
Complete Confidentiality Assured
www.leecalhoon.com
Posted on: June 24, 2008
REGIONAL
DIRECTOR QUALITY RESOURCE MANAGEMENT
openings located in:
OK,AZ,NM,and MS.
RISK MANAGER:
Eastern New Mexico
DIRECTOR OF CASE MANAGEMENT;
Western AZ
ASSISTANT CEO:
Central PA
Gail Stavis
SRA
400 West Cummings Pk. Ste. 6900
Woburn, MA 01801
Tel. (781)938-0990
Fax (781)933-5385
email: gail@search-research.com Posted
on: June 19, 2008
Administrative
Director of Quality - Richmond, VA
Director/VP Quality – FL (West)
Director
of Quality – FL (Southeast)
Division
Director, Quality – TN
Division
Director, Quality – FL
Director
of Quality – HI
Clinical
Data Administrator – GA
Administrative
Director of Quality – FL (Panama
City)
Director
of Quality – SC
Division
Director, Case Management – FL (Tallahassee)
Director of Case Management - SC Edwards & Greer
Healthcare Partners, LLC
1525 Old Louisquisset Pike
Building B, Suite 202
Lincoln, RI 02865
Direct: 401- 451-4179
Fax: 401- 475-6638
www.edwardsandgreer.com
date posted: March 28, 2008
Interprofessional Fellowship Program in Patient
Safety beginning July 2008 Purpose
The purpose of the Interprofessional Fellowship Program in Patient
Safety is to develop leaders with vision, knowledge,
and commitment to lead patient safety efforts in the 21st century.
The program includes both patient safety specific and supporting
core competencies: (1) Patient Safety Specific (Theoretical Underpinnings),
(2) Teamwork and Collaboration, (3) Transformational Leadership,
(4) Patient-Centered Care, (5) Evidence-Based Practice, and
(5)
Informatics and Use of Data. During
the 1-year full-time fellowship program, the fellow is expected
to complete one significant patient safety
project under
the supervision
of an established expert in patient safety. Fellows are encouraged
but not required to seek VA employment after completion of
the fellowship. This fellowship location is the Lexington
VA Hospital,
Lexington, KY in collaboration with the VA National Center
for Patient Safety and partnership with the University
of Kentucky. Eligibility
Applicants must meet the following program requirements: US citizenship and completion of all requirements needed to be
a fully credentialed independent practitioner in their field
at a VA facility. Physicians must be either board-eligible or certified in a
recognized medical specialty. Clinical
fields that recognize independent practitioners possessing
degree
levels below that of Master’s Degree (e.g., Registered
Nurse or Registered Dietitian) must have completed a Master’s
Degree (or all requirements for the degree) to be eligible. Nurses,
social workers, and health care administrators must possess at
least a master’s degree.
-
Applicants
in academic fields that do not involve clinical certification
or licensure but
that can
be applicable to health systems (e.g. anthropology,
sociology, computer science/medical informatics, engineering,
etc.) must
have received an advanced degree in their field,
or demonstrate that
all requirements for such a degree have been
completed.
Funding
Stipend
rates are determined by VA Office of Academic Affiliations, depending
on the discipline
and previous education
of the trainee.
For physicians, the stipend rate will
be based on years of previously completed ACGME accredited
residency training
and equivalent
experiences as determined by OAA and
index
rates approved at the affiliated
university and the respective VA facility.
Application
and Start Dates
The deadline for application for fellowships
beginning
July
1, 2008 is March30,
2008 and February
1, 2009 for
fellowships beginning July 1, 2009.
Application
Process. Applicants will be required to submit an application
that includes a letter,
of no more than three
pages,
stating short
and long term professional goals,
clinical or other pertinent background, a statement
of personal goals
for the fellowship,
a full curriculum
vitae, and two letters of recommendation.
Selection and Selection Criteria.
A selection committee will review
and
rank applications
based on the
following criteria:
quality
of credentials and experience,
commitment to remain in the VA
system, match
between personal
goals
and planned program
activities,
and
strength of recommendations. The
first ranked applicants will be
offered fellowships.
Rankings
will be used
to determine offerings
if earlier ones are unable to enter
the fellowship.
For additional
information:
date posted:
November 4, 2007
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