Quality Improvement Sr. Program Manager

Location: Orange, California US

Notice

This position is no longer open.

Job Number: 3382

Position Title: Quality Improvement Sr. Program Manager

External Description:

Alignment Healthcare was founded with a mission to revolutionize health care with a serving heart culture. Through its unique integrated care delivery models, deep physician partnerships and use of proprietary technologies, Alignment is committed to transforming health care one person at a time.

By becoming a part of the Alignment Healthcare team, you will provide members with the quality of care they truly need and deserve. We believe that great work comes from people who are inspired to be their best. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment community.

Position Summary:

Provide leadership, coordination, and project planning to ensure development and implementation of integrated processes and systems that will support internal goal.

 

The Quality Improvement  Senior Program Manager will report to the Sr. Director of Star and is responsible for implementation of new business, oversight of network management, facilitate information exchange between the Star team and provider network specific to quality/Star, support improvement activities within the Medicare STAR program, including project management, process improvement, campaign coordination, and outcomes measurement. This position will encompass all STAR related areas including HEDIS, CAHPS, HOS, and administrative measures.

 

General Duties/Responsibilities (May include but are not limited to):

·       Possess a deep understanding of the Medicare STAR program and lead the new business implementation and execution of strategy to improve outcomes.

·       Enhance the relationship with market groups and provider offices by engaging in participation with Joint Work Groups, Joint Operation Committee meetings, and efficiently and effectively responding to requests for information and successfully resolving issues as identified. 

·       Provide analysis/review of projects, outputs/solutions to Star Leadership

·       Track and report on outcomes and KPI’s for the program to ensure progress is met throughout the various project life cycles for designated market.

·       Utilize available tools, technology, and data to create sophisticated reporting that paints a clear picture and allows for informed analysis and decision-making.

·       Develop project work plans by defining tasks, setting deadlines, assigning responsibilities, and procuring resources.

·       Execute activities by leading interdisciplinary workgroups in analyzing, planning, and implementing programs, processed and workflows. Effectively facilitates teams and manages relationships.

·       Monitor and control work by measuring progress and correcting course when activities go beyond scope or are not meeting goals and objectives.

·       Collaborate in strategy, planning and execution of quality initiatives and HEDIS campaigns for the Medicare STAR program. This may include material development, mailing campaigns, IVR calling campaigns, case review, and other cross-functional initiatives to improve member outcomes.

·       Maintain positive relationships within Alignment Healthcare business units and operational departments and other project stakeholders by coordinating information exchange, keeping stakeholders informed of progress and risks, and maintaining project documentation.

·       Exercise creativity and flexibility by determining the appropriate combination of knowledge, skills, tools, and techniques for assigned projects.

·       Ensure patient privacy is protected by adhering to HIPAA standards, company policies and procedures, and other federal, state, and local requirements.

Minimum Requirements:

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.

 

1.       Minimum Experience:

a.       Minimum 3-5 years of experience in a health plan, managed care, or medical group/IPA setting, preferably in quality improvement, HEDIS, or the Medicare STAR program.

2.       Education/Licensure:

a.       Bachelor’s degree (BA or BS) from four-year college or university in a health-related field (Health Science, Health Administration, or related) required.

b.       Valid Driver’s License

3.       Other:

a.       Proficient in Microsoft Office (Outlook, Excel, Work, PowerPoint, Teams required. Visio and Access are preferred) and familiar working with large data sets.

b.       Knowledge of medical terminology and HIPAA.

c.       Mathematical skills, attention to detail, problem solving, and analytical skills are essential.

d.       Self-starter; able to work independently with minimal supervision.

e.       Demonstrated leadership ability.

f.        Strong communications skills: written, verbal, and interpersonal

4.       Work Environment:

    1. The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Essential Physical Functions:

The physical demands 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.

 

  1. While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.
  2. The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.

 

Alignment Healthcare, LLC is proud to practice Equal Employment Opportunity and Affirmative Action. We are looking for diversity in qualified candidates for employment: Minority/Female/Disable/Protected Veteran.

If you require any reasonable accommodation under the Americans with Disabilities Act (ADA) in completing the online application, interviewing, completing any pre-employment testing or otherwise participating in the employee selection process, please contact careers@ahcusa.com.

City: Orange

State: California

Location City: Orange

Location State: California

Community / Marketing Title: Quality Improvement Sr. Program Manager

Company Profile:

Alignment Healthcare was founded with a mission to revolutionize health care with a serving heart culture. Through its unique integrated care delivery models, deep physician partnerships and use of proprietary technologies, Alignment is committed to transforming health care one person at a time.

By becoming a part of the Alignment Healthcare team, you will provide members with the quality of care they truly need and deserve. We believe that great work comes from people who are inspired to be their best. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment community.

EEO Employer Verbiage:

Alignment has implemented a policy requiring all new hires to receive the COVID-19 vaccine and booster.  Proof of vaccination and booster will be required as a condition of employment subject to applicable laws concerning exemptions/accommodations.  This policy is part of Alignment’s ongoing efforts to ensure the safety and well-being of its staff and community, and to support public health efforts.

Alignment Healthcare, LLC is proud to practice Equal Employment Opportunity and Affirmative Action. We are looking for diversity in qualified candidates for employment: Minority/Female/Disable/Protected Veteran.

If you require any reasonable accommodation under the Americans with Disabilities Act (ADA) in completing the online application, interviewing, completing any pre-employment testing or otherwise participating in the employee selection process, please contact careers@ahcusa.com.