Supv, Quality Improvement

Provides leadership and oversight for day-to-day operations of the quality improvement coordination staff including the overall coordination and supervision of activities as it relates to state and regulatory quality compliance, HEDIS and Stars performance, and quality improvement initiatives.

Essential Functions:
  • Supervises a team of QI Coordinators and QI Care Gap Coordinators focused on quality improvement tasks aimed at achieving successful outcomes and benefit maximization towards members care.
  • Oversees processes and procedures to ensure compliance with contractual, regulatory (Federal/State) and annual quality metric reporting.
  • Monitors and tracks production and quality driven work/outcomes on assigned team. Monitors associates' performance, productivity and quality through standard reports.
  • Assigns and distributes workload, monitors productivity and quality levels.
  • Conducts one-on-one coaching and provides associates feedback routinely and as needed. Provides counseling/corrective action procedures when required.
  • Provides significant input and delivery of associates' performance evaluations and hiring/terminations.
  • Conducts training for new associates and re-training based on changing policy and procedure.
  • Prepares and completes projects, reports and assignments as needed to meet departmental goals and initiatives.
  • Assists in the implementation of and maintains a standardized quality management plan and program to ensure compliance with external regulatory and accreditation requirements.
  • Assist in researching and developing performance measurement and outcome studies to assess and improve the health status of the membership. Assist in planning, organizing and managing the design, development and analysis of a wide variety of topics relevant to health care services.
  • Maintains a knowledge base of HEDIS requirements and implementing clinical performance methods to improve HEDIS performance.
  • Attends department and/or quality improvement related meetings in the absence of manager.
  • Makes process improvement recommendations to senior leadership.
  • Acts as primary contact for escalated calls or issues or that require additional research and/or special handling, and investigates issues of an unusual nature and proposes solutions in a clear and concise manner.
  • Additional duties as assigned.
Additional Responsibilities:
    Candidate Education:
    • Required A Bachelor's Degree in a related field HealthCare, Nursing, Public Health, Health Administration (preferred)
    • Required or equivalent work experience
    Candidate Experience:
    • Required 3 years of experience in directly related Quality Improvement job duties
    • Required 4 years of experience in a managed care environment
    • Required 1 year experience in leading/supervising others
    • Preferred Other Medicare / Medicaid experience
    Candidate Skills:
    • Intermediate Other Excellent knowledge of JCAHO, URAC, AAAHC and NCQA standards
    • Intermediate Knowledge of community, state and federal laws and resources
    • Intermediate Demonstrated interpersonal/verbal communication skills
    • Intermediate Demonstrated written communication skills
    • Intermediate Demonstrated analytical skills
    • Intermediate Demonstrated problem solving skills
    • Advanced Ability to work in a fast paced environment with changing priorities
    • Intermediate Ability to multi-task
    • Advanced Ability to effectively present information and respond to questions from families, members, and providers
    • Intermediate Ability to effectively present information and respond to questions from peers and management
    • Intermediate Ability to influence internal and external constituents
    • Intermediate Ability to lead/manage others
    Licenses and Certifications:
    A license in one of the following is required:
    • Preferred Licensed Practical Nurse (LPN)
    • Preferred Licensed Specialist Clinical Social Worker (LSCSW)
    • Preferred Certified Professional in Healthcare Quality (CPHQ)
    Technical Skills:
    • Required Intermediate Microsoft Word
    • Required Intermediate Microsoft Outlook
    • Required Intermediate Healthcare Management Systems (Generic)
    • Preferred Spanish

    About us
    Headquartered in Tampa, Fla., WellCare Health Plans, Inc. (NYSE: WCG) focuses exclusively on providing government-sponsored managed care services through Medicaid, Medicare Advantage and Medicare Prescription Drug Plans to families, children, seniors and individuals with complex medical needs. WellCare is a Fortune 500 company, and in 2018, was recognized as a Fortune "World's Most Admired Company", ranking in the top five among the health insurance and managed care industry-a testament to the hard work and dedication of the company's nearly 9,000 associates who each day live WellCare's values and deliver on its mission to help its members live better, healthier lives. The company serves approximately 4.4 million members nationwide as of Dec. 31, 2017. For more information about WellCare, please visit the company's website at EOE: All qualified applicants shall receive consideration for employment without regard to race, color, religion, creed, age, sex, pregnancy, veteran status, marital status, sexual orientation, gender identity or expression, national origin, ancestry, disability, genetic information, childbirth or related medical condition or other legally protected basis protected by applicable federal or state law except where a bona fide occupational qualification applies. Comprehensive Health Management, Inc. is an equal opportunity employer, M/F/D/V/SO.