Quality Project Manager (Michigan)

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Position Summary
Supportive of State of Michigan Quality Contract deliverables, QAPI Program and regulatory standards. Processes and evaluates complex data and information sets in the development of strategic solutions to business issues and initiatives through direction setting and project management work. Responsibilities include assimilating information to proactively develop quality activities aligned with program goals and objectives; linking the quality management activities to business goals; advance business objectives by supporting and connecting diverse teams, fostering productive partner relationships, and applying deep quality expertise to help teams translate quality insights into business strategy.

Responsibilities

• Works with Director of Quality to assist in making business decisions based on the results of research and data analysis
• Leads cross functional teams to assist the health plan departments in integrating quality into their strategic and operational plan
• Evaluates and prioritizes recommendations for quality improvement to senior health plan management
• Helps to evaluate the Plans HEDIS Strategy and makes recommendation for improvement in closing gaps in care, to achieve NCQA HEDIS metric benchmarks
• Helps to develop strategy and improve Auto Assignment Algorithm (AAA) band ranking performance
• Helps to develop and improve CAHPS Member Satisfaction Survey scores/outcomes
• In partnership with functional areas and business owners, works to improve Michigan specific Apple Consumer Guide scores
• Helps to develop and implement improvement strategy for NCQA Star rating
• Works to help facilitate and improve Quality Withhold metrics, as defined by the State on an annual frequency
• Works with Dental Plan Vendors to improve Dental Program Strategy and performance outcomes to align with State and National benchmarks
• Develops and implements the infrastructure of the QM program and patient safety strategy and PQOC analysis/issues
• Directs/provides enhancements to business processes, policies, and infrastructure to improve operational efficiency across the organization
• Influences department business owners and leaders to reach solutions to meet the needs of stakeholders, both internal and external
• Provides comprehensive analysis of state PIP's, barriers, and opportunities and presents results of improvement efforts and ongoing performance measures to plan management

Required Qualifications

- 5+ years of progressive experience in a regulatory environment and/or quality management

· At least 5+ years of managed care experience

Preferred Qualifications

- Project Management skills and proficiency

· Proficiency with Microsoft Office Suite applications and other common computer and office software

- PMP Certification

- Lean Six Sigma (Green/Black Belt)

- Tableau Dashboards/Analytics

-Medicare / Medicaid experience

-Experience with HEDIS Metrics, CAHPS Member Satisfaction Surveys, NCQA Accreditation, Compliance Audits and/or MI State Reporting / Compliance

Education
· Bachelor’s degree or equivalent managed care experience

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$60,300.00 - $132,600.00

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls.  The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors.  This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. 
 

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