Director of Quality Health

Job Summary:

Leading the CHP care management team, this position will drive strategic planning, business structure and drive improved member outcomes.   In addition, day-to-day responsibilities generally include oversite of:  the clinical team, quality improvement, disease management, provider and patient satisfaction, prescription utilization, behavioral health and establishing core criteria for performing medical reviews and medical informatics, among others. This role will also focus on clinical strategies with the ability to develop and design quality measurement and improvements. 

 

Qualifications:

  • 7 years of health/insurance experience with 5+ years of clinical or managed care experience with a combination of medical, Rx and mental health backgrounds;
  • Strong working business knowledge at both a high level and a more drilled down level.
  • Supervisory and management skills are required;
  • Thorough knowledge of medical terminology and familiarity with trends.
  • Excellent multi-tasking, organizational, delegation and decision-making skills;
  • Outstanding written communication skills;
  • Ability to perform large work volumes with high degrees of accuracy;
  • PC proficiency, including MS Office;
  • Knowledge of managed care, preferably in health care setting;
  • Understanding the importance of maintaining confidentiality; able to maintain strict confidentiality standards; 
  • Exceptional personal character, including a strong work ethic, positive attitude, and willingness to assist others at all times.

 

Job Duties and Responsibilities: 

Develop and implement key committee’s objectives for medical input, quality initiatives, compliance and appeals.

Customize care management to CHP’s unique student health population

Handle disease management initiatives that result in reporting tools, resources and information to improve quality and care for patients.  

Responsible for clinical performance and review for patients using behavioral health services with the ability to utilize social workers or other alternative resources that may specialize in treatment outcomes that are more efficient and result in measureable improvements.

Develop core criteria and performing medical/Rx reviews that foster quality and efficiencies while helping to support processes that improve operational results.

Reporting to:  President

 

Please send your resume and completed application to CHP Human Resources at:

Mail: Consolidated Health Plans, Human Resources, 2077 Roosevelt Avenue, Springfield, MA 01104-3503

Fax: (413) 452-5329 Attn. Human Resources

Email: human_resources@consolidatedhealthplan.com

Phone: (413) 733-4540 ext. 120

 

Employment Application

Download Employment Application

 

For more information contact us at human_resources@consolidatedhealthplan.com or call us at (413) 733-4540 ext. 120