Who we are:
Meridian, a WellCare Company, is part of a national network of passionate leaders, achievers, and innovators dedicated to making a difference in the lives of our members, our providers and in the healthcare industry.
We provide government-based health plans (Medicare, Medicaid, and the Health Insurance Marketplace) in Michigan, Illinois, Indiana, and Ohio. As a part of the WellCare Family of companies, we deliver healthcare excellence to millions of members nationwide.
Our associates work hard, play hard, and give back. Meridian associates enjoy an exceptional experience and culture including special events, company sports teams, potlucks, Bagel Fridays, and volunteer opportunities.
A Day in the Life of a Manager of Quality Improvement:
This position is responsible for achieving, supporting and maintaining the performance goals of Meridian Health Plan. This includes developing and coordinating MHP’s activities, efforts, and initiatives related to performance and regulations of the National Committee for Quality Assurance (NCQA), URAC or general accreditation including Accreditation, HEDIS and CAHPS, as well as clinical requirements for State of Michigan, OFIR, MAHP, and other quality performance initiatives as determined by MHP.
- Oversees all initiatives within the QI department that are specific to NCQA, URAC or general accreditation and/or regulatory review
- Manages the NCQA, URAC or general accreditation QI measures and all initiatives, activities and efforts for meeting and maintaining performance rates. Develops and oversees QI initiatives as needed to achieve all QI goals required for NCQA, URAC or general and DCH, OFIR, and any other regulatory agency.
- Oversees all QI activities including: QIP, Work Plan, QIC meetings and QI policies and procedures
- Provides the Quality Improvement Committee with reports of patterns or trends identified through quality improvement activities
- Coordinates quality activities including but not limited to: clinical studies to meet regulatory requirements and NCQA, URAC or general accreditation standards, primary care physician medical record documentation reviews, educational assistance to committees and providers regarding quality management, preparing quarterly quality management reports for submission to the Board of Directors
- Provides oversight and direction to the HEDIS Coordinators, Quality Coordinators, Quality Nurse and Medical Record Abstraction Team.
- Collaborates with the Director and the Managers of other departments for efficient and effective processing and administration of MHP and QI department initiatives, issues and outcomes
- Analyzes HEDIS and CAHPS outcomes to identify potential barriers, interventions and opportunities for improvement
- Monitors work flows for efficiency and develops work plans and work orders to address needed process changes
- Develops multidisciplinary training and education programs for staff, providers, and members regarding HEDIS, CAHPS, and NCQA, URAC or general accreditation
- Serves as a liaison for the health plan office concerning quality management activities with outside agencies
- Responsible for completion of corporate HEDIS Reporting, including: HEDIS Roadmaps, NCQA IDSSs, Audit Preparation, and staff training.
- Initiates, documents, maintains, and provides to the human resources department all appropriate personnel records, with supervisory evaluations, attendance records, professional licensure verification, action plans, and all other personnel matters for each employee under her/his supervision
- Attends all meetings applicable to the position outside the organization.
- Consistently demonstrates compliance to HIPAA regulations, professional conduct and ethical practice
What you can bring to Meridian:
- Bachelor’s degree in nursing or a related field is required.
- Current license to practice as a Registered Nurse in the designated state is preferred.
- 3 to 5 years experience in quality improvement activities is required.
- Experience in word processing and Microsoft Office is required.
- Preveious experience in managed health care and Medicaid programs is preferred.
What Meridian can offer you:
- Our healthcare benefits include a variety of plans that are effective on the first day of employment for our new full-time team members.
- Opportunity to work with the industry’s leading technologies and participate in unique projects, demonstrations, conferences, and exclusive learning opportunities.
- Meridian offers 401k matching that is above the national average.
- Full-time Meridian employees are eligible for tuition reimbursement towards Bachelor’s or Master’s degrees.
- Meridian was named Detroit's #1 Fastest Growing Company by Crain's Magazine, so it is a great time to get involved with Meridian.
Equal Opportunity Employer