Manager Quality Improvement - MedStar Health : Job Details

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General Summary Of Position

Responsible for assisting with the implementation, integration, and operational direction of the QI program within MedStar Family Choice (MSFC). This includes organizing and directing the activities of Quality Improvement Services, monitoring provider processes and outcomes, overseeing audits (Del Marva and HEDIS), acting as a liaison between QI and other departments, and assisting the Medical Director with State reports and meetings. We are committed to recruiting, retaining, and advancing associates from diverse backgrounds, skills, and talents at all levels.

Primary Duties and Responsibilities

• Assist in developing department goals, policies, procedures, and standards, ensuring compliance with regulations.
• Serve as a liaison between IS and clinical teams to identify and resolve workflow/system issues, utilizing technology to improve decision-making and effectiveness.
• Support staff development by helping set personal and educational goals. Develop and implement training programs for software and clinical issues.
• Organize and participate in QI/UM Committee meetings and other departmental and state meetings, including preparing agendas and minutes.
• Assist in developing the annual QA plan and perform QA appraisals.
• Coordinate with the Medical Director on audits like Delmarva and HEDIS, acting as the lead contact.
• Provide coverage for staff as needed, demonstrating flexibility.
• Identify and lead new studies, applying conclusion, recommendation, action, and evaluation processes.
• Lead staff meetings and workgroups, address community and provider issues, and provide ongoing coaching and support.
• Ensure confidentiality and compliance with member privacy and consent procedures.
• Maintain knowledge of benefits, claims, and enrollment issues.
• Perform other duties as assigned.
• Prepare and analyze reports related to provider performance, maintaining centralized files.
• Respond promptly to quality issues following established protocols.
• Hire, train, evaluate, and manage department staff, including developing performance standards and conducting reviews.
• Supervise delegated entities, report findings, and develop Corrective Action Plans as needed.
• Gather and interpret data for HEDIS, audits, and quality issues, working closely with vendors and departments.
• Participate in meetings, committees, and community outreach efforts, representing the department and hospital.

Minimum Qualifications

• Bachelor's degree in healthcare or related field required; relevant experience with an associate's degree may suffice.
• 3-4 years of outpatient quality improvement experience required.
• 1-2 years of supervisory experience preferred.

Licenses and Certifications

• RN license in Maryland or District of Columbia preferred; certification in a healthcare-related field is also preferred.

Knowledge, Skills, and Abilities

• Effective communication skills, both verbal and written.
• Proficiency with Microsoft Office, especially Word, Excel, and PowerPoint.
• Ability to use a PC for data entry and retrieval.
• Knowledge of healthcare delivery trends, NCQA, HEDIS, InterQual, and local regulations is preferred.

This position has a hiring range of $80,995 - $152,027.