Quality Improvement Program Manager (Medicare)

Health Net, Inc. is a publicly traded managed care organization that delivers managed health care services through health plans and government-sponsored managed care plans. Its mission is to help people be healthy, secure and comfortable.

The Quality Improvement Program Manager will evaluate Star Rating program requirements and develop a quality program implementation strategy to improve Rating performance within all Health Net Medicare contracts located in multiple regions. This position will manage program implementation among multiple Health Net departments, regions and delegated/non-delegated provider groups and ensure all regulatory requirements, quality improvement accreditation standards and related government contractual obligations are met.

* Designs and implements quality improvement program(s)/projects to operational, clinical and member satisfaction Star rating and display measures. * Works with appropriate business units such as operations, sales/marketing, A&G, and medical management and/or define and leads ad-hoc teams necessary for implementing improvement program(s). * Designs and administers program training across impacted regions and departments. * Provides direction for the creation of new product lines (clinical/non-clinical) which require tailored team-based care and/or services for sub-populations. * Manages program/project budget. * Collaborates with data managers and systems managers to design and implement process improvement projects, health outcome measurement, monitoring and reporting of program performance. * Oversees the dissemination of member information reports to internal and external clients. * Coordinates the collection of data as well as the maintenance and analysis of all program evaluation components. * Participates in the development, implementation, and evaluation of an annual strategic plan. * Manages vendor relationships. * Performs other related duties as assigned.

* Bachelor's degree in Nursing or Master's degree in health related field **Certification/Licensure Required** * If licensed as an RN, must have and maintain a current, valid and unrestricted state RN license. **Experience Required** * Five years health care experience, including two to three years in a health plan role leading in the assessment, design and delivery of integrated health initiatives. * Prior experience in technical or clinical writing, analysis and project management preferred. * Or any combination of academic education, professional training or work experience, which demonstrates the ability to perform the duties of the position. **Knowledge, Skills & Abilities** * Working knowledge of the dimensions of health (physical, emotional, mental, social, spiritual, environmental) * Working knowledge of health surveillance, health care data analysis, cost/benefit design and analysis, behavioral change theories, and principles of program design/implementation/evaluation * Strong organizational skills and demonstrated collaborative, facilitation, negotiation, and problem solving skills * Excellent verbal and written communication skills as well as excellent presentation skills * Strong project management skills with the ability to manage multiple projects * Skills in designing, developing, marketing, delivering and evaluating programs and services * Extensive network and demonstrated resourcefulness in accessing programs, services, and providers * Demonstrated conceptual and strategic planning skills * Strong computer skills, including Access, Word, Excel and PowerPoint * Ability to learn new system applications and apply to data tracking, reporting and program implementation * Ability and willingness to work a flexible schedule and travel for program delivery as needed **Working Conditions** * The following section describes the general physical requirements for this position. Please note that constant refers to more than 81% of time; significant refers to 40-80%; and moderate refers to 20-40% of the time. * Operates personal computers, printers, facsimile, telephones, copy machines and other commonly used office accessories/equipment. * Exposed to confidential information and expected to maintain confidentiality at all times; must adhere to HIPAA rules and regulations. * May be required to work outside of normally scheduled hours as mandated by the client, project and/or workload (e.g. evenings, weekends, and/or holidays). * May be required to maintain established work pace, meet deadlines; may have last minute urgent requests. * Physical activity may include: twisting, reaching, kneeling, bending, stooping, squatting, crawling, grasping, grabbing, pushing, pulling, repetitive motion, climbing, etc. * Required to have visual acuity to determine the accuracy, neatness, and thoroughness of the work assigned. * Required to have hearing ability to receive detailed information through oral communication. * Required to have speaking ability to express or exchange ideas. * Constant concentration may be required on various subjects by listening, reading and thinking clearly. * Interaction with others may be required. May need to listen, think, and speak in order to interact with others. Business interactions and behavior between coworkers and/or external customers are required. This may require face-to-face or telephone interactions. * Thinking at work may include listening, learning, analyzing, evaluating, and the ability to interpret what is seen and/or heard, or to link information from one issue to the next. * Constant computer usage including typing and/or eye strain. * Significant repetitive arm, wrist, hand and finger motions -- making repetitive movements (e.g. key boarding, filing, data entry). * Moderate phone usage; headsets may be required. * Constant sedentary work (desk bound or seated). * Constant reading is required via computer screen and/or bound printed materials.