Position Summary:
The Quality Manager (QM) is responsible for the planning, organization, and successful execution of one or more quality programs for the Market Region. The Program consists of the CMS STARS Program. The QM is responsible for the motivation of the local partnership provider quality teams to achieve measurable gains within the program, as measured by internal and external metrics. Ensures the quality and timeliness of work performed, supervises and assists in the gathering of data (supplemental or otherwise) and the accurate entry into all systems and subsystems. Demonstrates the ability to work on multiple, complex projects and manages communication between partner quality staff, providers, health plans, market leadership and enterprise.
Essential Job Functions:
• Build relationships and motivate anchor partner quality staff to achieve long- range operational goals.
• Coordinate resources required to meet the business objectives. Manage the resolution of problems that are escalated.
• Continually review and evaluate the progress and performance of STARs and design developmental programs tailored to meet goals.
• Establish yearly goals in collaboration with the anchor partner, market leadership and enterprise leadership.
• Continually assess potential project risks. Creates and implements corrective action plans and develops new procedures resulting in meeting STAR goals.
• Initiates new programs, enhances existing programs and continuously assesses need for resources, tools and add-ons.
• Provides excellent and comprehensive communication and education to internal and external teams. Assists with Provider, staff and member training.
• May coordinate and oversee annual chart audit collection and health plan chart requests. Assists with member and provider communication as needed.
• Produces accurate metrics reports in a timely manner. Identifies areas that need improvement and initiates creative solutions (cost effective) to correct issues to meet and exceed our stated goals.
Required Qualifications:
1. Minimum Experience
• 5 or more years of experience in process management, and HEDIS/STAR experience.
• Experience in Quality initiatives and metrics performance.
• Must demonstrate good written and verbal communication skills.
• Must demonstrate proficient computer skills. Previous EMR experience is preferred and Excel experience is a must.
• Five or more years’ experience in project coordination or management of small, medium and large projects desired.
2. Education/Licensure:
• Bachelor’s Degree with emphasis in business administration or Health care preferred or equivalent experience.
Salary range shown is a guideline. Individual compensation packages can vary based on factors unique to each candidate, such as skill set, experience, and qualifications.
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What We Do
agilon health is transforming health care for seniors by empowering primary-care physicians to focus on the entire health of their patients. Through our platform and partnership model, agilon health is leading the nation in creating the system we need – one built on the value of care, not the volume of fees. We honor the independence of local physicians and serve as their long-term partner so they can be the physicians they trained to be.
agilon is built for physicians by physicians, as the patient-physician relationship is the cornerstone of care. We allow primary care physicians to take the long view of their relationships with patients, and to be confident in the long-term financial viability of their own practices. We do this through a Total Care Model that maintains the independence of physicians; unites them in a network of like-minded leaders; and integrates all of the components of a global risk business model into a single platform.
