Quality and Performance
Manager, Quality Improvement Program
Louisville , KY, United States

Your Future Evolves Here

Evolent Health has a bold mission to change the health of the nation by changing the way health care is delivered. Our pursuit of this mission is the driving force that brings us to work each day. We believe in embracing new ideas, challenging ourselves and failing forward. We respect and celebrate individual talents and team wins. We have fun while working hard and Evolenteers often make a difference in everything from scrubs to jeans.

Are we growing? Absolutely--62% in year-over-year revenue growth through 2015. Are we recognized? Definitely. We’re 12th on Forbes’ list of America’s Most Promising Companies for 2015, one of “Becker’s 150 Great Places to Work in Healthcare” in 2016, and our CEO was number one on Glassdoor’s 2015 Highest-Rated CEOs for Small and Medium Companies. If you’re looking for a place where your work can be personally and professionally rewarding, don’t just join a company with a mission. Join a mission with a company behind it.

What You’ll Be Doing:

The Manager, Quality Improvement Program is responsible for the oversight and direct performance of the Medicare Advantage D-SNIP program to include,  CCIP, HEDIS, HOS, CMS Reporting, QI Reporting, and related processes. Responsible for compliance with Federal and contractual obligations, including successful achievement of assigned incentivized health outcomes and business plan financial goals.

What You’ll Be Doing:

  • Plans, organizes and manages the development and implementation of the QI program processes, including strategies for successful outreach and education to members, providers and to community institutions for the purpose of promoting preventive health among members and increasing the rate of participation and compliance.
  • Coordinates and implements the development of recommended policies and programs. Coordinates, establishes and monitors achievement of departmental goals and objectives. Responsible for achievement of assigned standard compliance measures and compliance with all applicable Federal laws and regulations, as well as achievement of assigned incentivized health outcomes.
  • Coordinates and develops collaborative projects throughout the service and expansion areas that will support the goals of QI programs.
  • Collaborating across departments to implement interventions to improve performance for health outcomes such as HEDIS/Stars
  • Managing, tracking and reporting the QI program requirements as defined in the Model of Care
  • Monitoring QI activities for all departments as defined by annual work plan requirements for trends in performance.  Identifying and implementing opportunities for improvement.
  • Researches and evaluates, through data analysis, opportunities for additional collaborations that will assist eligible members in accessing care.
  • Represents the Passport Advantage Program at informational and educational sessions related to quality improvement. 
  • Works with multiple systems to inform members and Providers about QI programs services and arranges for the provision of those services. 
  • Facilitates the process of notifying members and Providers about the availability of program services.
  • Coordinates the provision of services when necessary.
  • Coordinates meetings with all Passport Advantage plan departments related to the provision of QI program services.
  • Performs other duties as assigned

The Experience You’ll Need (Required):

 

  • Bachelor’s Degree in Health Care or Equivalent required
  • 3-5 years in a health plan or managed care setting
  • 3-5 years of Quality Performance Improvement including HEDIS, HOS, Stars, Model of Care, CMS Regulatory requirements, Population Health.
  • 3-5 years’ experience working with Medicare population
  • Strong leadership skills.
  • Experience in presenting, communication and project management. Working with all levels of the organization. 

Finishing Touches (Preferred):

  • Master’s Degree in Healthcare Administration, Public Health,  or equivalent

Evolent Health is an equal opportunity employer and considers all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, or national origin.

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