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Corporate Medicare Quality: Associate Vice President
Job ID 2012-21168
Location US-VA-Virginia Beach
Search Category Quality
Type Regular Full-Time (30+ hours)
Posted Date 11/5/2012
Additional Locations ..
More information about this job:
Responsible for developing, coordinating, and implementing Medicare quality initiatives to include implementing the Medicare Quality Management Program, monitoring and evaluation of quality of care/service, appropriateness, continuous improvement, and results of actions across the continuum of care to members. May also be responsible for developing, coordinating, and implementing corporate-wide task force initiatives and new model development as the result of Medicare growth and Dual Eligible populations.
The incoming AVP, Corporate Clinical Quality Management will make a difference, affect change, and provide a significant contribution to the future of AMERIGROUP by responding to the priorities of key stakeholders. Specifically, the candidate should be proficient in developing and managing:
SNP Model of Care collaboration and submission process
Development, implementation and analysis of CCIP and QIP programs
Quality measure analysis
Clinical quality programs specific to a Medicare population
CMS audit activity as it relates to quality standards
Additional Responsibilities include:
Assures initial and on-going compliance with State and Federal quality improvement/assurance requirements; specifically, assures compliance with CMS QIP, CCIP requirements as well as all requirements from Chapter 5 of the CMS Managed Care Manual
Works with health plans and other corporate departments to develop a quality program for all LTSS lines of business.
Accountable for implementation of programs to improve Amerivantage CMS Star Ratings
Medicare quality managed care experience; A Master’s degree in a healthcare field is preferred, however a combination of Medicare, managed care and leadership experience will be considered in lieu of Masters preparation.
Other desirable personal attributes/values include:
Ability to “hit the ground running”
Other desired competencies include:
EDUCATION AND EXPERIENCE
• Bachelor’s Degree in a related discipline.
• MHA, MPH, MPA, or MSN
Years and Type of Experience
• 10 years progressive experience in data mining and HEDIS management.
• Minimum of five years quality improvement and/or risk management in an MCO setting.
• Minimum of five years leadership/management experience.
• Previous NCQA MCO accreditation experience.
• Experience with the Medicaid/Medicare population, preferably with clinical quality and outcomes
Specific Technical Skills
• Leader and working knowledge for data QC and data mining.
• HEDIS Management.
• Data Analysis.
• Data management skills.
• Proficiency in Microsoft Word and Excel.
• Previous NCQA accreditation and HEDIS reporting.
• Statistical data interpretation.
Certifications or Licensures
• Advanced knowledge base in areas of health plan quality improvement and risk management.
• Strong knowledge base and experience in HEDIS and QI measurement sets.
• Data programming and mapping skills.
• Ability to work effectively with physicians and other health care providers as well as with multi-disciplinary teams across departments.
• Excellent written and verbal communication skills.
• Excellent analytical and problem solving skills.
• Ability to work in a team environment.
• Ability to develop and give presentations.
The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Must be able to operate general office equipment including but not limited to: computer, phones and related media and information devices.
• Ability to communicate both in person and/or by telephone.
• Must be able to travel as needed and adhere to AMERIGROUP travel policies and procedures.
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