Quality care Director

Description of Work

The vendor shall provide assistance to fulfill the Quality Care Director position to perform these primary functions:

1. Oversee the development of the Quality Improvement Plan;

2. Work with practices and community providers in the implementation of the Quality Improvement Program;

3. Ensure the PCCM-e completes the required QIP and meets required benchmarks;

4. Review and report data to the Medical Director, and conveys information related to Quality Measures, QIPs, and any Agency directed quality initiatives adopted by the Agency to the PCCM-e;

5. Support the care coordination activities of those in the Region that are at the highest risk and cost along with other areas of focus as chosen by the PCCM-e; and

6. Ensure quality of services are provided in accordance with state and federal regulations.

The Personnel Qualifications

1. Education requirement is one of the following: a. Bachelor's degree in public health, public administration or healthcare quality and safety, master's degree preferred.

2. Certified Professional in Healthcare Quality (CPHQ) or equivalent experience related to healthcare quality

3. Clinical background preferred

4. Prior experience, at least one year, working with the Medicaid population.

5. Familiarity with Healthcare Effectiveness Data and Information Set (HEDIS), CAPHS, and other standardized quality measures/assessments

At least 3 years' experience related to population health management, including interpretation and presentation of data; identifying opportunities for improvement, and developing strategic plans to address quality deficits.

Population Health Management strategies Oversees the PCCM-e quality Improvement Plan by:

a. Systematic data analysis to target Medicaid recipients and providers for outreach, education, and intervention to improve health outcomes. b. Monitoring system access to care, services, and treatment including linkage to a Medical Home.

c. Monitoring quality and effectiveness of interventions to the population

d. Facilitating quality improvement activities that educate, support, and monitor Providers regarding evidence-based care for best practice.

e. Implementing clinical management initiatives identified as priorities by the Agency and the PCCM-e.

8. Must live in one of the following counties: Bibb, Colbert, Fayette, Franklin, Greene, Hale, Lamar, Lauderdale, Lawrence, Marion, Pickens, Sumter, Tuscaloosa, Walker or Winston.

9. Has not worked for and/or been employed by the Alabama Medicaid Agency within the past two years