At MemorialCare Health System, we believe in providing extraordinary healthcare to our communities and an exceptional working environment for our employees. MemorialCare stands for excellence in Healthcare. Across our family of medical centers and physician groups, we support each one of our bright, talented employees in reaching the highest levels of professional development, contribution, collaboration and accountability. Whatever your role and whatever expertise you bring, we are dedicated to helping you achieve your full potential in an environment of respect, innovation and teamwork.
The Quality Manager position is designed to provide, manage and document continuous activities that identify, evaluates and improves the quality and safety of care and services provided to all Seaside Health Plan members. The Quality Manager will maintain a system that utilizes structured, comprehensive review of the quality, safety and appropriateness of services delivered by the Seaside Health Plan departments and network of providers to assure compliance, risk mitigation and patient safety.
The QM Manager is responsible to maintaining a quality, risk and compliance management system that utilizes a structured, comprehensive review of the quality, safety and appropriateness of care delivered by the entire network of clinical services as well as to monitor all service elements through appropriate study designs and sound statistical techniques when monitoring, conducting studies and developing report.
The QM Manager will also regulate the Plan’s internal processes conforming and abiding by applicable state and federal regulations that governs Plan’s entity.
Principal Duties and Responsibilities:
* Responsible for the operational execution of the QM Program under the direction of the Chief Medical Officer.
* Responsible for the development, implementation and evaluation of the QM Program and Work Plan.
* Responsible for the operations and management of staff assigned to all QM activities for Seaside Health Plan, including monitoring and reporting as required by regulation or contract.
* Responsible for managing the QM staff.
* Responsible for oversight of Antifraud Plan requirements;
* Oversees regulatory compliance;
* Responsible for the daily management and implementation of the Safety and Risk Management programs;
* Acts as an educator and resource to all departments in matters involving Risk Management;
* Responsible for the compliance of Seaside Health Plan and providers’ policies, procedures, education, communication,
* oversight, and enforcement;
* Reports QM activities to the Quality Council.