MANAGER OF QUALITY OF CARE AND POPULATION HEALTH, HEALTH PLAN SERVICES

Location: Health Plan Services - 4896

Hours: 9:00AM -5:00PM

Salary is commensurate with years of experience

Job Title

Manager of Quality of Care and Population Health

Department

Health Plan Services

This position is exempt from Career Service under the CCH Personnel Rules.

Job Summary

The Manager of Quality of Care and Population Health develops and implements Health Plan Services initiatives that promote high quality of care for all Health Plan Services members. Collaborates with Health Plan Services and Cook County Health (CCH) leadership, clinical services, health plan committees, contracted providers and partners, and regulatory agencies on timely resolution of complex issues, reporting and data analytic activities required by State and Federal statute or regulation. The Manager of Quality of Care and Population Health designs and implements measures to minimize the risk of injuries and adverse incidents through adherence to quality standards, risk detection and prevention education. Supervises staff and leverages vendor/partner participation to lead these efforts.

General Administrative Responsibilities

Collective Bargaining

• Review applicable Collective Bargaining Agreements and consult with Labor Relations to generate management proposals
• Participate in collective bargaining negotiations, caucus discussions and working meetings

Discipline

• Document, recommend and effectuate discipline at all levels
• Work closely with labor relations and/or labor counsel to effectuate and enforce applicable Collective Bargaining Agreements
• Initiate, authorize and complete disciplinary action pursuant to CCH system rules, policies, procedures and provision of applicable collective bargaining agreements

Supervision

• Direct and effectuate CCH management policies and practices
• Access and proficiently navigate CCH records system to obtain and review information necessary to execute provisions of applicable collective bargaining agreements

Management

• Contribute to the management of CCH staff and CCH' systemic development and success
• Discuss and develop CCH system policies and procedures
• Consistently use independent judgment to identify operational staffing issues and needs and perform the following functions as necessary; hire, transfer, suspend, layoff, recall, promote, discharge, assign, direct or discipline employees pursuant to applicable Collective Bargaining Agreements
• Work with Labor Relations to discern past practice when necessary

Typical Duties

• Oversees management of Quality of Care grievances and concerns. This includes the grievance investigation and resolution process. Collaborates with Chief Medical Officer, Managed Care or designee to convene the Peer Review committee and oversee corrective action and improvement initiatives.
• Provides leadership and subject matter expertise to improve quality of care and safety of Health Plan Services members in accordance with quality management and regulatory requirements of health plan services.
• Hires, supervises, coaches and evaluates staff to implement quality of care management program.
• Develops program descriptions, policies and procedures, work plans, and annual program goals for approval by Health Plan Services leadership and governance committees to continually improve health plan quality.
• Engages and monitors network providers, vendors, and delegates to adhere to practice guidelines, Health Plan Services policies, State, Federal and accreditation standards, regulatory requirements and quality standards to minimize the risk of injuries and adverse incidents to members.
• Assures compliance with all monitoring and reporting of Quality of Care concerns in accordance with State, Federal, accreditation standards and CCH and Health Plan Services committees.
• Develops and implements audit processes and on-site quality reviews of providers and oversees audits of Health Plan Services.
• Participates in the Health Plan Services Delegation Oversight team to ensure oversight and ongoing monitoring of delegated entities' implementation of both an incident reporting and complaint/grievance systems to comply with applicable State and Federal laws.
• Analyzes the frequency trends and causes of actual or potential adverse incidents and collaborates with partners to develop and implement improvement initiatives and/or corrective action plans.
• Collaborates with leadership to implement the Quality Program and Quality workplan to achieve stated goals in accordance with Federal an