Program Manager, Quality Improvement

Program Manager, Quality Improvement

Cal Optima

Join Us in this Amazing Opportunity

We are a mission driven community-based organization that serves member health with excellence and dignity, respecting the value and needs of each person. If you are ready to advance your career while making a difference, review and apply today to help us build healthier communities for all.

The Team You'll Join

We are a mission driven community-based organization that serves member health with excellence and dignity, respecting the value and needs of each person. If you are ready to advance your career while making a difference, review and apply today to help us build healthier communities for all.

More About the Opportunity

We are hoping you will join us as a Program Manager (Quality Improvement) and help shape the future of healthcare where you ll be an integral part of our Quality Improvement team, helping to strive for excellence while we serve our member health with dignity, respecting the value and needs of each of our members through collaboration with our providers, community partners and local stakeholders.

This position has been approved to be Full Telework
.

Telework expectations: If telework is approved, you are required to work within the State of California only and if Partial Telework, also come in to the Main Office in Orange, CA, at least two (2) days per week minimum.

The Program Manager for Quality Improvement (QI) will provide oversight, coordination and staff support to the department for NCQA Accreditation, as well as for the quality requirements of the DHCS, DMHC and CMS. You will support Cal Optima Health s health plan and health equity accreditation efforts to ensure Cal Optima Health achieves its renewal accreditation. Specifically, you will work to monitor, enhance and strengthen Cal Optima Health s quality infrastructure, including program, policy, contract compliance and statutory and regulatory obligations with NCQA, DHCS, DMHC and CMS.

You will be able to complete a variety of detailed analyses, including the impact of accreditation and policy changes from NCQA, state of California, federal government, and regulatory entities while communicating these changes with QI leadership and affected areas. You will assist in developing and overseeing the Quality Improvement Health Equity Transformation Plan (QIHETP), and the annual work plan and evaluation, including ensuring alignment with organizational goals and regulatory requirements.

You will interact with Cal Optima Health s leadership, the NCQA, and state and federal regulatory agencies. Together, we are building a stronger, more equitable health system.

• 80% - Program Support
• Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.
• Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.
• Leads Cal Optima Health through the NCQA Health Plan and Health Equity accreditation process and renewals for all applicable products and provides leadership to all business areas to ensure standards are known and met.
• Leads and facilitates NCQA regulatory audits and audit readiness activities for the department.
• Stays current on NCQA accreditation standards as well as local, state and federal health care environment; identifies issues and communicates areas that may impact Cal Optima Health s QI programs.
• Ensures all NCQA related policies are reviewed and updated to meet NCQA and regulatory compliance annually; works directly with regulatory and compliance to ensure submissions are reviewed timely and with legal review.
• Assists in the development and bookmarking of documents used for NCQA accreditations and other regulatory agency reporting submissions.
• Engages and collaborates with all external NCQA and regulatory related vendors and organizations, including but not limited to NCQA and NCQA consultants, to ensure standards are known and met and accreditation surveys are submitted accurately and timely.
• Initiates and maintains contact with key business owners to ensure proper submission of required documentation for the accreditation and renewal survey and regulatory audits.
• Assists the manager and director in developing annual regulatory compliant QIHETP documents, including the QIHETP description, annual workplan and evaluation.
• Monitors quality improvement actions and activities across the organization to ensure the QIHETP description and annual work plan are executed as planned and meet regulatory requirements.
• Manages policies for the department and collaborates with the appropriate business owners to update policies as needed to maintain compliance with NCQA, DHCS, DMHC, CMS, and other regulatory requirements.
• Represents QI at various Cal Optima Health committee meetings such as the Quality Improvement Health Equity Committee (QIHEC) and its…