Director Of Quality Managemet
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Nature of Work
Special hiring rates:
$50,250 at Bureau for Medical Services
This PMI is the director of the Office of Quality Management (OQM), operates a Quality Management (QM) infrastructure that promotes high quality healthcare for Medicaid members; assures cost effective access to healthcare in the least restrictive setting, and provides administrative, process and technical direction and expertise for monitoring and evaluating the appropriateness and quality of healthcare services, member satisfaction, and the results of healthcare Quality Improvement (QI) efforts for all Medicaid members statewide. Manages the External Quality Review Organization (EQRO) contract for the three statewide Medicaid Managed Care Plans (MCP's) and oversees their compliance with state and federally required healthcare quality assessments, interventions, and reporting. Responsible for global Medicaid (Fee for Service and Managed Care) quality strategies, including working with BMS leaders and contractors to set, monitor, implement and promote a quality agenda for BMS. Responsible for all healthcare quality assessment and technical assistance for all Medicaid managed care programs, including the program for foster care children. Guides and evaluates healthcare quality improvement activities currently in four Medicaid managed care programs at three managed care organizations and oversees the same quality improvement activities for WVCHIP. Responsible for BMS Directed Provider Payment (DPP) programs including coordinating with the WV hospital associates and statewide healthcare providers to collect and report healthcare quality measurements to CMS quarterly, and to also submit them to CMS annually. Oversees annual CMS core quality measures collection and submission for adult, child, and health home populations. Collects data for healthcare quality measures requiring coordination with the EQRO vendor, data warehouse vendor and other state agencies. Develops, implements, and assesses healthcare quality improvement projects for FFS members. Participates in selection and reporting on BMS budget related healthcare quality measures. Identifies, monitors, and addresses health disparities and other social determinants of health. Supervises staff in department. Preference may be given to an RN, candidates with certification in healthcare quality, such as certified professional in healthcare quality. Other related job duties as assigned.
Minimum Qualifications
Training: Master's degree from an accredited college or university in the area of assignment.
Substitution: One year of full-time or equivalent part-time paid experience as described below may substitute for the Master's degree.
Experience: Three years of full-time or equivalent part-time paid professional experience in the area of assignment, one year of which must have been in a program administration capacity.
Substitution: Post-graduate training in the area of assignment may substitute through an established formula for the non-supervisory experience.
Areas of Assignment:
Behavioral Health
Community Health
Emergency Medical Services
Environmental Health
General Administration
Health
Health Facilities Licensure and Certification
Health Planning
Health Promotion
Investigation
Legal
Rural Health
Social Services
Volunteer Services