Quality Improvement Manager

  • Aids Healthcare Foundation
  • Fort Lauderdale, FL , United States
  • Jan 05, 2018
Full time Nurse Management

Job Description

Does the idea of doing something that really makes a difference in people’s lives while being well-compensated intrigue you? Are you looking to work for an organization that encourages growth and success from each and every one of its employees?
If so, AIDS Healthcare Foundation is the place for you!
Founded in 1987, AIDS Healthcare Foundation is the largest specialized provider of HIV/AIDS medical care in the nation. Our mission is to provide cutting edge medicine and advocacy, regardless of ability to pay. Through our healthcare centers, pharmacies, health plan, research and other activities, AHF provides access to the latest HIV treatments for all who need them.
AHF’s core values are to be:
• Patient-Centered
• Value Employees
• Respect for Diversity
• Nimble
• Fight for What’s Right
STILL INTERESTED? Please continue!
Essential Duties & Responsibilities

Includes the following. Other duties may be assigned.
• Leads AAAHC survey preparation.

• In collaboration with department Directors, Plan Medical Director and the National Director Quality
   Management (NDQM) develops monitoring tools to measure and internally report departmental
   adherence to the domains of the AAAHC standards. Implements, maintains and reports the 
   outcomes of the monthly monitoring of AAAHC adherence no less than quarterly.
    o Reports findings and results of corrective action plans, when one is in place, to the Chief, VP   
      and Medical and National QM Directors.

• Supports compliance with AAAHC standards and participates in AAAHC survey preparation.
• Assists with preparation for HEDIS data collection, validation audits, data submission as required.
• Works collaboratively with the NDQM and PMD to design and execute programs and projects to 
   improve HEDIS, HOS, CAHPS, QIP, PIP monitoring rates.
• Leads the Florida Provider Satisfaction survey project. Conducts survey and submits results on time
   to Executive Management, the Quality Management Committee and required reporting agencies.
• Develops and maintains a calendar of contractual, accreditation, and regulatory reporting 
   requirements. Collaborates with Compliance and provides all subject matter and due dates for the
   compliance Report Manager application so reporting can be tracked for timeliness.
• Assures contractually required quality activities are occurring. Reports these monthly status reports 
   to Executive Management, quarterly reporting to the QMC and required monthly/quarterly and/or
   annual reporting to oversight agencies. Reports such activities according to timelines outlined in Plan
   Guidance or contracts. Examples of such monitoring and reporting are:
    o CHCUP
    o EPSDT
    o AHCA Performance Measures
    o Satisfaction surveys
• Facilitates and writes Florida QIP’s/CCIP’s/PIP’s and may consult and contribute on quality  
   improvement initiatives for other states and programs.
• When non-compliance with the contractual, regulatory or accreditation activities are found,
   collaborates with the department and develops corrective action plans (CAP). Reports status of
   CAPs on a monthly basis to Executive Management through the completion and six month follow-up
   of the CAP.
• Collaborates with the Information Technology Department and with the Data Analyst to obtain 
   relevant information to track and trend quality indicators.
• Conducts audits of Primary Care Provider and Case/Disease Management records/charts to identify
   areas for improved quality of care.
• Leads and conducts external audits of contracted network providers to maintain the quality and
   integrity of the network.
• Establishes and utilizes benchmarks and thresholds as quality indicators.
• Performs selected outcome studies.
• Participates in developing a training program related to Quality Improvement.
• Provides QI Training to Plan employees and network providers.
• Manages the Risk Management Program
• Manages the Complaint and Grievance Process. Assures processes are followed and all timeliness 
   requirements continually are met.
    o Performs incident (complaint/grievance) investigations.
    o Assures Medicare and Medicaid standards, communication, investigation, follow-up and time  
       frames for Grievance Management are met at all times.
    o Educates Member Service Staff on Medicare and Medicaid standards for complaints and   
    o Develops corrective action plans in collaboration with management as needed. Monitors CAP to  
       assure correction and maintenance of correction has occurred. Reports results to QMC.
• Monitors and reports on AAAHC.
• Participates on quality improvement teams.
• Assists in the development of the annual QI Plan.
• Conducts analysis of data collected to accomplish established QI Program goals.
• Assists the Compliance Department on projects, activities, meetings, audits, etc to carry out 
  compliance program
• Assures ongoing, quarterly, semiannual and annual QI reports and evaluations are completed as
   prescribed in the overall QI plan.
• Prepares quarterly QI reports for submission to the Managed Care Executive Oversight Committee,
   Quality Management Committee and Board of Directors.
• Submits an annual evaluation of the QI Plan to the NDQM, PMD, Chief and Executive Oversight 
   Committee no later than March of each year for the previous calendar year.
Participation in AHF Meetings/Committees

Attends Quality Management Committee
Attend Quality Department Staff Meetings
Attends AHF meetings as assigned.
External AHCA, CMS or other required meetings as assigned by the NDQM or VPMC.
Supervisory Responsibilities
This job supervises one QM analyst.
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Education and/or Experience

• Bachelor’s degree BSN/BA from four-year college or university; or Associate Degree Nursing and one 
   to two years related experience and/or training or equivalent combination of education and  
• Certificate in Risk Management or able to obtain certification within 4 months of employment.
Computer/Software Skills & Abilities

To perform this job successfully, an individual should have knowledge of Database software; Internet software; Spreadsheet software and Word Processing software
Language Skills

Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations. Ability to write reports, business correspondence, and procedure manuals. Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public.
Mathematical Skills

High Skills: Ability to work with mathematical concepts such as probability and statistical inference, and fundamentals of plane and solid geometry and trigonometry. Ability to apply concepts such as fractions, percentages, rations, and proportions to practical solutions.
Reasoning Ability
Very High Skills: Ability to define problems, collect data, establish facts, and draw valid conclusions. Ability to interpret an extensive variety of technical instructions in mathematical or diagram form and deal with several abstract and concrete variables.
Other Skills & Abilities/Qualifications

• Five years experience in acute care, case management utilization review, or quality improvement
• Extensive knowledge of Microsoft Access, Excel and Word.
• Successful completion of a college level statistics class.
• BS/BA in health sciences, health management, or a related field preferred.
Certificates, Licenses and Registrations

Licensed Registered Nurse with the Florida Board of Registered Nursing.
Certified Risk Manager
We at AIDS Healthcare Foundation believe that each individual is entitled to equal employment opportunities without regard to race, color, creed, gender, sexual orientation, gender identity, marital status, national origin, age, veteran status or disability.
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