Manager, Clinical Quality Improvement Job Listing at Medical Mutual in Brooklyn, OH (Job ID 2400629)

Description

This is a remote opportunity in Ohio. Note: quarterly and occasional/ad hoc/situational in-office requirement in Brooklyn, Ohio.

Founded in 1934, Medical Mutual is the oldest and one of the largest health insurance companies based in Ohio. We provide peace of mind to more than 1.2 million members through our high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans.

Manages the day-to-day activities and staff of the health plan's clinical quality improvement operations, including HEDIS and provider quality. Develops, implements and analyzes outcomes of all Clinical Quality Improvement programs and processes delivered to members and providers.

Responsibilities

·         Manages Clinical Quality Improvement program and staff to include the activities of HEDIS, Medicare Stars, and Provider Quality.

·         Devises and manages the implementation of strategies to improve clinical outcomes and promote wellness for all lines of business.

·         Ensures coordination of clinical quality improvement (CQI) activities among functional areas, monitors the progress of CQI activities against the annual CQI work plan and ensures potential quality of care issues are channeled appropriately for investigation and resolution.

·         Manages the design, development, and implementation of clinical quality improvement projects, clinical practice guidelines and health promotion projects. Directs the clinical abstraction process to coordinate chart review for HEDIS and report back findings to network providers.

·         Provides advice and consultation to management and department staff. Maintains expertise of national accreditation standards, clinical quality regulations and changes within the clinical field and assures compliance across assigned managed care product lines. Participates and chairs various committees.

·         Coordinates client based medical informatics analysis. Oversees the collection, analysis and reporting of data relative to health-related baselines, outcomes and return on investment.

·         Performs other duties as assigned.

Qualifications

·         Bachelor's degree in Nursing, Healthcare Administration or related healthcare field required; Master's degree preferred.

·         8 years progressive health care experience in case, utilization, or quality management; 3 years of which are in management or high-level individual contributor role.

·         Certified Professional in Healthcare Quality (CPHQ) preferred.

·         Registered Nurse with current State of Ohio unrestricted license preferred.

·         Comprehensive knowledge of CMS Part C regulations, HEDIS, Medicare Stars rating and NCQA standards.

·         Comprehensive knowledge of process and performance improvement methods and tools: Plan Do Study Act (PDSA) Define, Measure, Analyze, Improve and Control (DMAIC).

·         Knowledge of financial/business analysis techniques.

·         Knowledge of clinical care models and quality frameworks.

·         Demonstrated ability to design, plan and deliver programs to large and small groups.

·         Strong verbal and written communication skills.

·         Intermediate to advanced Microsoft Office skills.

·         Strong project management skills with the ability to handle multiple, concurrent projects through to completion.

Medical Mutual is looking to grow our team! We truly value and respect the talents and abilities of all of our employees. That's why we offer an exceptional package that includes:

A Great Place to Work:

• We will provide the equipment you need for this role, including a laptop, monitors, keyboard, mouse and headset.
• Whether you are working remote or in the office, employees have access to on-site fitness centers at many locations, or a gym membership reimbursement when there is no Medical Mutual facility available. Enjoy the use of weights, cardio machines, locker rooms, classes and more.
• On-site cafeteria, serving hot breakfast and lunch, at the Brooklyn, OH headquarters.
• Discounts at many places in and around town, just for being a Medical Mutual team member.
• The opportunity to earn cash rewards for shopping with our customers.
• Business casual attire, including jeans.

Excellent Benefits and Compensation:

• Employee bonus program.
• 401(k) with company match up to 4% and an additional company contribution.
• Health Savings Account with a company matching contribution.
• Excellent medical, dental, vision, life and disability insurance — insurance is what we do best, and we make affordable coverage for our team a priority.
• Access to an Employee Assistance Program, which includes professional counseling, personal and professional coaching, self-help resources and assistance with work/life benefits.
• Company holidays and up to 16 PTO days during the first year of employment with options to carry over unused PTO time.
• After 120 days of service, parental leave for eligible employees who become parents through maternity, paternity or adoption.

An Investment in You:

• Career development programs and classes.
• Mentoring and coaching to help you advance in your career.
• Tuition reimbursement up to $5,250 per year, the IRS maximum.
• Diverse, inclusive and welcoming culture with Business Resource Groups.

About Medical Mutual:

Medical Mutual's status as a mutual company means we are owned by our policyholders, not stockholders, so we don't answer to Wall Street analysts or pay dividends to investors. Instead, we focus on developing products and services that allow us to better serve our customers and the communities around us.

There's a good chance you already know many of our Medical Mutual customers. As the official insurer of everything you love, we are trusted by businesses and nonprofit organizations throughout Ohio to provide high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement and individual plans. Our plans provide peace of mind to more than 1.2 million Ohioans.

We're not just one of the largest health insurance companies based in Ohio, we're also the longest running. Founded in 1934, we're proud of our rich history with the communities where we live and work.

At Medical Mutual and its family of companies we celebrate differences and are mutually invested in our employees and our community. We are proud to be an Equal Employment Opportunity and Affirmative Action Employer. Qualified applicants will receive consideration for employment regardless of race, color, religion, sex, sexual orientation, gender perception or identity, national origin, age, marital status, veteran status, or disability status.

We maintain a drug-free workplace and perform pre-employment substance abuse and nicotine testing.