Director of Quality Improvement Job in Ontario 91764, California US

NAMM California, a leader in the managed care industry, has an immediate opening for a Director of Quality Improvement in Ontario, CA. 

RESPONSIBILITIES:


• Supports CQIC and subcommittees
• Develop initial QI program documents for review/approval by CQIC, peer review committee BOD.
• Initial development of QI work plan identifying the responsibilities of the operations units that support program implementation.
• Formulate quarterly reports to the B.O.D. reporting status of program implementation.
• Participate in the initial evaluation of potential delegates for credentialing and UM, reviewing and evaluating delegate’s reports and performing annual review of delegates.
• Prepare for external reviews by health plans and regulators
• Assist in development of research design and methodologies for proposed QI initiatives and disease management programs.
• Monitor the plans QI programs to insure compliance to regulation, accreditation agencies, and contracted health plans.
• Develop state-wide P P's related to QI, credentialing and health education.
• Oversees implementation of credentialing program, P P's.

SKILLS REQUIRED:
• Active RN or LVN license in the state of California, CPHQ, CCM, or DPUR desired
• 5+ years experience in both Managed Care and UM/MM/CM
• 3+ years managerial experience
• 5+ previous experience developing departmental infrastructure
• Strong knowledge of HMO and MCO operations, and continuous quality and utilization/medical management techniques and operations
• Demonstrated ability to develop and implement new business units and service lines
• Previous external accreditation experience (NCQA, JCAHO) preferred
• Strong knowledge of Disease Management implementation models
• Intermediate/Advance computer applications, including Microsoft Software.

BENEFITS:
Competitive benefits include but are not limited to: Medical, Dental, Vision, Short and Long Term Disability, Life Insurance, Educational Reimbursement, Paid Holidays, 401K, and more!