Manager of Quality Improvement

As the Manager of Quality Improvement, you will be responsible for operational management, account management, and business development for specific contracts. Operational management includes team accountability for evaluation measures, deliverables or project requirements. Health management services may include: population health management, practice facilitation, medical/utilization management, case/disease/maternity management and/or quality improvement activities. You will be responsible for monitoring compliance in accordance with client and contract deliverables as well as service/accreditation requirements as applicable. You will also be responsible for supervising program staff and providing technical guidance and training to staff related to the contract/program operations.

This is a Hybrid position, requiring onsite days in our West Des Moines, Iowa office on Mondays and Fridays, and potentially other days as needed.

Manages the day-to-day operations of multiple and diverse health management lines of service and/or contracts/programs

Leads team in creation of a strategic plan, implementation of plan, evaluation and ongoing management to ensure contract deliverables/program requirements and evaluation measures/metrics are met and/or exceeded within assigned funding/budget

When deliverables/requirements are at risk, facilitates analyses and initiatives action plan

Develops and maintains relationships with team stakeholders

Provides technical assistance, including issue research and resolution

Develops and implements process improvement methods for an organization whose philosophy is continual improvement

Depending on the scope of assigned area, may facilitate national programs/projects

Ensures the operations are completed in a timely, satisfactory, compliant manner within assigned funding/budget

Participates in sales, business development and proposal work activities including development of concept papers, contributing content or review of proposals as a subject matter expert

Has financial accountability for monitoring budgets and financials for assigned contracts

Coaches, guides and directs team members to achieve individual, team and organizational objectives

Fulfills the Telligen Management Philosophy that "Managers coach, engage, and support our people to achieve results"

Provides resources and support as needed to meet the departmental and Company goals and specific contract/program requirements

Represents the company and presents at meetings and/or conferences

Works externally with providers or clients as assigned

Makes recommendations for improvements and/or efficiencies to management

Initiates opportunities to expand knowledge, skill development, and certifications which enhance quality improvement activities and the achievement of contract deliverables

Stays abreast of industry trends and changes. Performs miscellaneous duties as assigned

Four-year degree in nursing with a current Iowa RN license or the ability to become licensed in the state of Iowa

5 years of experience in medical coding and utilization management including: claims, billing, prior authorization, and appeals

3-5 years of experience managing projects and professional staff; demonstrated experience working in a fast paced and deadline driven environment

Experience with URAC and NCQA health plan accreditation specific to utilization management

Experience with claims post pay medical necessity reviews

Experience with reviewing medical codes for coverage determination including establishment of medical policy and demonstrated knowledge of how utilization management and medical policy work together to support evidence-based coverage determinations, and code update implementations including ICD-10 and CMS

Knowledge of the following Leadership Principles

• Strategic planning, implementation and evaluation
• Leading Change
• Leading people: coaching, guiding and training
• Conflict management: difficult conversations
• Knowledge of financial principals including budgeting
• Building and maintaining stakeholder relationships
• Positions working on specific contracts may require U.S. Citizenship
• This is a Hybrid position, requiring onsite days in our West Des Moines, Iowa office

Knowledge of the following healthcare quality principles:

• Health care services, health care organizations and programs
• Information management processes, electronic health records and healthcare information technology
• Quality improvement concepts, principles and process tools
• Basic statistics, data collection techniques, data analysis and graphic representation of data
• Familiarity with Iowa HHS Administrative Rules and Administrative Rule Waiver
• Certified Professional in coding and billing
• Facilitation including Group Process Facilitation
• QI Process: Focus-Analyze-Develop-Execute/ Plan-Do-Study-Act
• Experience dealing with sensitive information

Telligen is one of the most respected population health management organizations in the country. We offer clinical, analytical, and technical expertise to support local, Tribal, and national partners, state and federal government programs, and employers and health plans.

Over our 50-year history, health care has evolved - and so have we. What hasn't changed is our deep commitment to those we serve. Our success is built on our ability to adapt, respond to client needs and deliver innovative, mission-driven solutions.

Our business is our people and we’re seeking talented individuals who share our passion and are ready to take ownership, make an impact and help shape the future of health.

Benefits: A general description of the benefits and other compensation available for this position can be found in Telligen's Benefits Summary.

We’re on a mission to transform lives and economies by improving health.

Ownership: As a 100% employee-owned company, our employee-owners drive our business and share in our success.

Community: We show up - for our clients, our communities and each other. Being a responsible corporate partner is part of who we are.

Ingenuity: We value bold ideas and calculated risks. Innovation thrives when we challenge the status quo and listen to diverse perspectives.

Integrity: We foster a respectful, inclusive, and collaborative environment built on trust and excellence.

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