To provide affordable specialty pharmacy services of the highest quality, along with patient-centered clinical management and auxiliary services that deliver optimal patient outcomes.
Summary: The Sr. Quality and Compliance manager is responsible for overseeing the corporate Quality Improvement (QI) program, including: creating, implementing and reviewing Quality Improvement projects within the company. They will work closely with the compliance officer to ensure the company is in compliance with all federal, state, and regulatory standards. Stay up to date with all regulatory changes concerning accreditations and update policies and procedures as necessary. They will be responsible for training staff and the local contact for questions and concerns. They are responsible for process improvement, ensuring accreditation measures and standards are met, tracking surveys, grievances, access to service, operational measures and identifying areas for improvement to target specific outcomes related to quality and compliance.
Duties and Responsibilities include the following. Other duties may be assigned.
1. Provide staff support in the development, implementation and evaluation of performance improvement.
2. Collect, research, investigate and present data and information for various reports and projects.
3. Maintain key quality metrics dashboard.
4. Utilize tools such as Microsoft Excel to interpret, analyze and summarize key data points.
5. Document and report improvement activities within the organization and externally as appropriate.
6. Demonstrate problem solving, leadership, conflict management, and team building skills in order to ensure a productive work environment and achievement of goals
7. Utilize problem solving techniques (examples include PDCA and DMAIC) to document QI project plans, facilitate the plan and report end results
8. Analyzes and evaluates the effectiveness of project activities for results and outcomes related to strategic goals.
9. Identify, solve and prevent possible quality related issues through tools such as root cause analysis and CAPA.
10. Contributes to the preparation of annual program descriptions and evaluations.
11. Demonstrates ability to utilize project management skills - organization, priority setting, delegation, managing multiple projects.
12. Serve on and report to the Quality Improvement Committee/Clinical Oversight Committee on project progress and operational data/trends.
13. Create and provide training sessions as needed on quality related topics in collaboration with the education and training team.
14. Facilitate and organize committee meeting on a minimum of a quarterly basis.
15. Seek, share and implement best practices
16. Supports organization to meet regulatory and accreditation standards, comply with corporate policy, reach appropriate benchmarks and promote patient satisfaction.
17. Develop, implement and execute policies and procedures to ensure compliance with all regulatory standards including but not limited to: State and Federal Law, State Board of Pharmacy regulations, HIPAA, HHS, URAC Specialty Accreditation, URAC Mail Service Accreditation, ACHC Accreditation, VIPPS Accreditation and regulatory agencies.
18. Responsible for overseeing MedCart's Quality Improvement (QI) program, including: creating, implementing and reviewing quality improvement projects and preparing QIC meeting minutes- tracking and trending of all required measures
19. Provide support and project management to Managed Care for third party specialty credentialing .
20. Create/update policies and procedures to ensure MedCart meets payor requirements
21. Review supplier and vendor qualification programs and conduct vendor audits (DSCSA).
Bachelor's degree (B. A. / B. S.) from four-year College or university required. Six plus years related healthcare experience and two plus years quality experience preferred.
Certificates and Licenses:
Quality and compliance related certification strongly preferred.
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations. Ability to write reports, business correspondence, and procedure manuals. Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public.
Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, percentages, area, circumference, and volume. Ability to apply concepts of basic algebra and geometry.
Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.
To perform this job successfully, an individual should have knowledge of Microsoft products and Training software.
Knowledge, Skills and Other Abilities:
* Knowledge of process improvement methodologies such as Lean, Six Sigma DMAIC
* Time management
* Oral and written communication
* Project management
* Customer service
* Phone and computer skills
* Critical thinking
* Ability to maintain open and effective lines of communication with the education and training staff, managers, and other Diplomat employees
* Friendly and caring demeanor
* Detail oriented
* Ability to multi-task
* Ability to work well with various personalities and work within a team
* Dependable and has the ability to act with discretion maintaining levels of strict confidentiality
* Knowledge of internet navigation and research, e-mail, fax transmission and copy equipment are essential
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is regularly required to talk or hear. The employee is frequently required to walk; sit and use hands. The employee is occasionally required to stand.