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Manager, Quality in Tallahassee, FL at KEPRO

Date Posted: 9/29/2018

Job Snapshot

Job Description

Quality Manager

Summary Description

Responsible for overseeing day-to-day operations of Quality Management. Responsible for the development and monitoring of quality monitoring activities.

Accountabilities / Essential Functions

  • Facilitates all QA activities, provides continuous improvement consulting services to internal customers, employs knowledge of performance improvement strategies, principles, methodology, techniques and data analysis.
  • Ensures the implementation of key performance indicators and maintains systems for tracking, reporting and improving performance.
  • Ensures the promotion of awareness of customer requirements throughout the operation.
  • Reviews audit results and identify the severity of audit findings or the risk associated with the findings.
  • Reviews and evaluate reported crisis (i.e., highly-urgent service related problem with immediate negative implications for the Company) and assists with the formulate a plan of action for handling the incident/issues based on area of expertise/responsibility.
  • Execute QA plans to ensure they meet current and future business requirements (e.g., best practices, quality, volume and product growth, regulatory requirements, & new product introductions).
  • Statewide training of nursing facility and hospital providers, state staff, and internal staff/field evaluators.
  • Assists in preparing and submitting reports and/or deliverables timely as required.
  • Other duties as assigned

The list of accountabilities is not intended to be all-inclusive and may be expanded to include other education- and experience-related duties that management may deem necessary from time to time.

Supervisory Responsibility

  • Quality oversight of licensed clinicians completing PASRR evaluations of individuals with suspected or confirmed mental illness to determine the presence of a Serious Mental Illness (SMI), as defined by 42 CFR 483.102(b)(1), Intellectual Disability or Other Related Conditions (ID/RC) as defined by 42 CFR 483.102(b)(3) and F.A.C. 59G-1.040(2)(b).
  • Quality initiatives to meet contract compliance and all workflows to remain within required turnaround times.

Qualifications

  • BA/BS minimum, Master’s degree preferred.
  • Florida Licensure required (LCSW, LMHC, RN, clinical psychologist)
  • Formal training or certification in quality preferred. (CPHQ, ISO, Six Sigma)

Skills, Knowledge Abilities

  • Knowledge of Federal Regulation 42 CFR, Chapter 483
  • Knowledge of Florida Administrative Code 59G-1.040
  • Knowledge of psychiatric disorders as defined by the most current Diagnostic and Statistical Manual in use.
  • Knowledge of standards of practice related to determination of Level of Care.
  • Knowledge of standards of practice related to mental health, intellectual and developmental disabilities, geriatric, and other disorders typically requiring long term care placementAbility to take initiative, provide leadership, maintain confidentiality, meet deadlines and work in a team environment.
  • Knowledge of CQI tools, methods and techniques such as Six Sigma.
  • Grasp and understanding of SPC (Statistical Process Control).
  • Knowledge of URAC, NCQA &/or ISO background a plus.
  • Analytical skills must be highly developed with an ability to objectively evaluate data and perform statistical analysis.
  • Knowledgeable and skilled in applying McKesson’s InterQual criteria, Milliman criteria, and various Medicaid and contract policy requirements.
  • Excellent communication (verbal and written), organizational, presentation, and interpersonal skills required.
  • Ability to prioritize and manage multiple assignments.
  • Knowledge of Microsoft software applications (Word, Excel, PowerPoint, Access).

Experience        

  • Minimum of 3 to 5 years of management or quality management experience in a health-related field.
  • Quality management and/or compliance experience, required.
  • Experience identifying organizational needs and recommending the appropriate improvements.

Mental and Physical Requirements        

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 will be made as required by law in an attempt to enable an individual with a disability to perform the essential functions of this job. While performing the duties of this job, the employee is regularly required to sit for prolonged periods of time; key and/or control objects; interact extensively with internal and external customers; occasionally lift and/or move objects weighing up to 10 pounds; and occasionally travel within the state.

 EOE AA M/F/Vet/Disability

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