The Director of Quality Management is administratively responsible for evaluating individual and systemic quality of care initiatives. Integrating quality throughout the organization as it relates to specific populations. The Director will plan, implement, and evaluate process improvement initiatives. Oversees the quality of care complaint process of receiving, tracking, resolving, and trending. Works in conjunction with the provider network management team to develop and maintain a credentialed provider network. Directs and leads initiatives to ensure support from all departments in order to meet strategic business objectives and regulatory requirements such as clinical improvement programs, process improvements, Quality Improvement Programs (QIPs) or Performance Improvement Plans (PIPs), Workplan and the Annual Evaluation of performance against the Workplan.
Competencies and Skills:
Demonstrates excellent communication skills.
Demonstrates strong project management skills.
Demonstrates strong working knowledge of managed care and CQI principles.
Demonstrates excellent management and interpersonal skills.
Demonstrates strong analytical, problem-solving, strategic thinking, and organizational skills.
Demonstrates ability to work well in a team environment.
Demonstrates ability to prepare and present high-level presentations.
The specific statements shown above are not intended to be all-inclusive. They represent typical elements considered necessary to successfully perform the job
·Physician Assistant with PA licensure, Pennsylvania-licensed RN or Certified Professional in Healthcare Quality by the National Association for Healthcare Quality and Certified in Healthcare Quality and Management by the American Board of Quality Assurance and Utilization Review Providers.
·Bachelor's degree in Business, Health Administration or related field required. Master's degree preferred.
·Minimum seven years of experience in a related field required with minimum of three years in a managed care environment preferred.
·Minimum five years management experience required.
·Proven experience in a hands-on, day-to-day operating environment where results can be directly attributable to individual's effort required.
·Experience with market analysis, strategic implementation and evaluation preferred.
·Experience with HEDIS® Programs/Metrics.
Working Conditions/Physical Demands:
Work is typically performed in an office environment.
OUR PURPOSE & VALUES: Everything we do is about caring for our patients, our members, our students, our Geisinger family and our communities. KINDNESS: We strive to treat everyone as we would hope to be treated ourselves. EXCELLENCE: We treasure colleagues who humbly strive for excellence. LEARNING: We share our knowledge with the best and brightest to better prepare the caregivers for tomorrow. INNOVATION: We constantly seek new and better ways to care for our patients, our members, our community, and the nation.
Geisinger Health Plan (GHP) is the health insurance component of Geisinger and serves over 460,000 members in Pennsylvania. Begun in 1985, GHP provides high quality, affordable health-care benefits for businesses of all sizes, individuals and families, and Medicare beneficiaries.
About Geisinger: Founded more than 100 years ago, Geisinger serves more than three million residents throughout central, south-central and northeastern Pennsylvania and southern New Jersey. Our physician-led system is comprised of 30,000 employees, including 1,600 employed physicians, and consists of 13 hospital campuses, the Geisinger Health Plan, Geisinger Commonwealth School of Medicine and two research centers
Internal Number: 63596
At Geisinger, our innovative ideas are inspired by the communities we serve – like our Fresh Food
Farmacy, a program that delivers life-saving healthy alternatives to patients with diabetes. With additional tools like our MyCode Community Health Initiative, one of the first health system genome sequencing
programs, and our new asthma app suite that we developed in partnership with AstraZeneca, it’s no wonder we’re ranked one of the Top 5 Most Innovative Healthcare Systems by Becker's Hospital Review. We continually work towards continuous improvement in a culture where everyone has a voice and firmly believe that better begins with all of us.
Founded more than 100 years ago, Geisinger serves more than three million residents throughout central, south-central and northeastern Pennsylvania and southern New Jersey. Our physician-led system is comprised of 30,000 employees, including 1,600 employed physicians, and consists of 13 hospital campuses, the Geisinger Health Plan, Geisinger Commonwealth School of Medicine and two research centers.
What you do at Geisinger shapes the future of health and improves lives – for our patients, communities, and you.