Director, Quality Management
Updated Brand
 Charlotte, NC

Requisition Number: DIREC02658

The Quality Management Director is responsible for leadership, management, and oversight of quality functions in support of the organization’s mission and vision This position is key to the development and implementation of the quality improvement strategic plan. This position has a direct fiscal responsibility for all functions which fall under his/her supervision. The responsibilities of this role include but are not limited to collaboration with key departments and external stakeholders, enhancing operational processes, and the development of policies and protocols for improved quality. This position is also required to be familiar with contractual and regulatory requirements.

Essential Functions

The Clinical Quality and HEDIS QM Director is responsible for (though not limited to):

  • Manage and oversight of Clinical Quality and HEDIS functions.
  • Develop a standardized quality management plan and strategy program to ensure compliance with regulatory and accreditation requirements.
  • Provide oversight of monitoring systems for quality improvement activities.
  • Ensure high risk and unusual events are monitored concurrently and retrospectively as they occur.
  • Research and develop performance measurement and outcome studies to assess and improve the health status of the membership. Plans, organizes and manages the design, development and analysis of a wide variety of topics relevant to health care services.
  • Design and develop methodologies for preventive care and health care evaluations. Researches and documents current health care standards for use in study design and methodologies.
  • Conducts preventive studies to evaluate the continuity and coordination of care and to assess the quality and utilization of health care services.
  • Provides guidance to clinical staff regarding study design, methodology, data analysis and reporting.
  • Maintain a knowledge base of HEDIS requirements and implements clinical performance methods to improve HEDIS performance.
  • Prepare and present executive and detail level summary of quality activities as needed.
  • Prepare, compile, review and present reports to the Continuous Quality Improvement Committee and executive leadership as requested and/or scheduled.
  • Provide oversight of training for staff and the provider network on various topics and QM functions.
  • Work in collaboration with other departments to develop quality solutions.
  • Provide QM representation and or lead Cross Functional committees as assigned.
  • Oversight of applicable policies and procedure.
  • Oversight of contractual and Accreditation performance metrics.
  • Attend State meetings as needed to stay informed of changes in clinical best practices, performance metrics, local, State, Federal and Division requirements.
  • Performs other duties as assigned.

Qualifications

  • Must be knowledgeable about the rules/regulations and clinical practices that guide the services provided.
  • Must have experience working with HEDIS software vendors (management, building relationships, issue resolution etc.).
  • Must possess strong clinical knowledge of the treatment/service needs of the persons served and possess skills in assessing strengths and needs, treatment plan development and clinical service implementation.
  • Must possess strong leadership skills and be able to be effective in getting task done while working through other people.
  • Ability to develop and implement strategic goals and plans.
  • Must provide management and oversight of the CQI processes.
  • Ability to effectively present information and respond to questions from internal and external stakeholders.
  • Must be self-motivated and able to work with a wide variety of individuals and possess the ability to negotiate effectively in working with teams, providers and other departments to address issues of concern.
  • Must possess organization skills that allows a balance a wide variety of task in a time effective manner.
  • Ability to retain large amounts of information and be able to interpret written rules/regulations and make them applicable for others in a manner that meets their position and learning style.
  • Detail oriented, able to independently organize and manage multiple tasks.
  • Must also be a resourceful problem solver who thrives in a fast-paced environment.
  • Demonstrate proficiency in Microsoft Office products (such as Word, Excel, Outlook, etc.) and be able to quickly learn new software tools.

Education and Work Experience

Education:

  • Applicant must hold a Nursing Degree (RN) and must have a current and active license in good standing through the NC Board of Nursing.

Experience:

  • Experience in quality improvement, analysis, development, public health or related area
  • 5 + years of providing supervision and project management experience
  • Healthcare/Health Plan experience preferred
  • 2+ years of HEDIS experience and/or knowledge
  • Specialization area of Psychiatry is desired.
  • Experience in behavioral health and Quality Management is highly preferred.

Valid Driver’s License Required:

Yes

Travel Type:

Domestic

Percentage: 5 - 15

Language:

Read

Write

Speak

English

Spanish

Other:

Licensure and/or Certification

Licensed to practice as a Registered Nurse in the State of North Carolina

Equal Opportunity Employer/ Protected Veteran/ Individuals with Disabilities

Cardinal Innovations is firmly committed to the policy of providing equal employment opportunity (EEO) to all of its employees and applicants for employment without regard to race, age, color, sex, religion, creed, veteran status, genetic information, national origin, non-job related disability, sexual orientation, and/or gender identity or expression (except as mandated by law). Employment at Cardinal is based solely on a person's merit and qualifications directly related to professional competence. For that reason, we consider qualified applicants regardless of criminal histories, consistent with legal requirements. Our equal employment opportunity philosophy complies with federal, state and local law and applies to all aspects of employment with Cardinal, including recruiting, hiring, training, transfer/promotion, compensation, benefits and termination.

If you have a disability or special need that requires accommodation, please let us know by contacting Cardinal's Human Resources department at HumanResources@cardinalinnovations.org Someone from the HR team will reach out to see how we may be able to assist.

Physical Demands/ Working Conditions

Physical Demands

N/A

Rarely

Occasionally

Frequently

Constantly

Walking, Standing, Sitting, Stooping

Balancing, Lifting, Carrying, Pushing, Pulling

Climbing, Kneeling, Crouching

Reaching, Handling, Grasping, Feeling

Talking, Hearing

Repetitive Motions

Coordination: Eye, Hand, Foot

Working Conditions

N/A

Rarely

Occasionally

Frequently

Constantly

Extreme Temperature Cold/ Heat

Humidity

Wet

Noise

Hazards

Vibration

Other:

Valid Driver’s License Required:

Yes

Travel Type:

Domestic

Percentage: 5 - 15