AmeriHealth Caritas

Job Summary

The Director of Quality Management is responsible for the Outcomes Management and Quality Improvement Plan, a program of systematic and objective activities designed to continuously monitor, evaluate, and improve the processes of delivering behavioral health and substance use services, services for intellectual/developmental disabilities, and the quality of clinical care and services provided to children, youth, young adults, and their family/caregivers. The Director is responsible for a formal outcomes assessment process that is standardized, reliable, and valid in accordance with industry standards.

Work Arrangement: Hybrid and must reside in Pennsylvania

Responsibilities:

• Oversight of complaints and grievances, credentialing, quality of care, policies and procedures, NCQA, internal and external audits and treatment record reviews.
• Provides quality leadership in the development of new and improved clinical and administrative processes to maximize effective operations and ensures that contract deliverables are met.
• Provides organization-wide monitoring of outcomes, data analysis, and improvement of quality, clinical and non-clinical processes. Utilizes this data to support and collaborate with all departments. Requires extensive experience developing, interpreting, and presenting reports and analyses to support decision-making and collaboration across departments.
• Supervises a team of quality coordinators, manages assignments and provides feedback on job performances and goals
  
  

Education:

• Master’s degree in social work, nursing, counseling, or doctorate in psychology required.
• Must be a PA licensed RN, physician, physician’s assistant or a licensed or certified MH Professional or is a Certified Professional in Healthcare Quality (CPHQ) or is Certified in Healthcare Quality and Management (HCQM)
  
  

Experience:

• 10 years’ experience in healthcare and in quality assurance and improvement.
• Knowledge and experience of statistics and research to conduct data analysis/evaluation.
• Excellent communication skills: Verbally and in writing with all internal and external customers.
• Strong presentation skills required.
• Ability to handle conflict and difficult situations.
• Strong time management, project management, and organizations skills.
• Ability to use PC’s in a Windows based environment.
• Ability to foster growth and teamwork.
• Strong & demonstrated leadership and management skills resulting in the ability to make decisions independently and manage personnel.
  
  

Our Comprehensive Benefits Package

Flexible work solutions including remote options, hybrid work schedules, Competitive pay, Paid time off including holidays and volunteer events, Health insurance coverage for you and your dependents on Day 1, 401(k) Tuition reimbursement and more.

For roles that are 100% remote or hybrid, you must have access to a reliable high-speed internet connection to support daily job responsibilities. A minimum bandwidth of 50 Mbps download and 5 Mbps upload is required. Those fully remote associates residing in states where service is required by contract, law, or regulation will be allowed to submit for reimbursement.

Your career starts now. We’re looking for the next generation of health care leaders.

At AmeriHealth Caritas, we’re passionate about helping people get care, stay well and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we’d like to hear from you.

Headquartered in Newtown Square, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services.

Discover more about us at www.amerihealthcaritas.com.