Job Summary

Veterans, Reservists, Guardsmen and military family members are encouraged to apply!!

We offer remote work opportunities (AK, AR, AZ, CA, *CO, HI, IA, ID, IL, KS, LA, MN, MO, MT, NE, NV, NM, ND, OK, OR, SD, TX, UT, *WA, WI & WY only)

Under the direction of the VP, Clinical Operations, this position is responsible for the development, implementation, evaluation and direction of the organization's Clinical Quality Management (CQM) program. The director will lead program activities that include developing and implementing quality and safety program processes, desk procedures and communications; overseeing multiple quality studies; collaborating with VP of Clinical Operations to develop an annual CQM program plan; overseeing and monitoring clinical quality outcomes dashboard and data reports; and collaborating with the clinical leadership to oversee and monitor multiple quality activities and committees in support of our Peer Review Organization (PRO). The position is accountable and responsible for managing CQM staff, meeting CQM contractual requirements and ensuring compliance with URAC standards.

Education & Experience

Required:

• Registered Nurse with current unrestricted license or similar certification
• Bachelor's degree in nursing or related field or closely related experience
• 5 years of clinical experience in Medical Surgical and/or Behavioral Health healthcare
• 3 years of experience in Quality Management
• 5 years of progressive supervisory or management experience
• Knowledge HEDIS and Administrative measures

Preferred:

• Master's Degree in Nursing, Health Care Administration or a related field
• Experience utilizing an electronic medical record system
• Certified Professional in Healthcare Quality (CPHQ)

Key Responsibilities

• Supervision of all multi-functional PRO activities carried out by quality staff.
• Responsible for all activities associated with the TRICARE Quality Monitoring Contractor, Joint Quality Assurance Surveillance Plan (QASP), Joint Quality and Safety Committees and other quality committees or plans.
• Monitors performance with respect to quality initiatives for contract performance and/or internal improvement activities.
• Ensures contract compliance with government reporting requirements and focused studies operations.
• Ensures URAC readiness for fundamental quality standards.
• Participates on all quality committees to include submitting monthly, quarterly, and annual reports.
• Maintains the confidentiality and non-discoverability of all quality issues.
• Ensures appropriate documentation, implementation, and evaluation for corrective actions on defined clinical quality and patient safety issues are maintained.
• Supports Clinical Quality Management through education, policy development and consultation.

• Responsible for hiring, training, and supervision of direct and indirect subordinates.
• Supports the annual review of the Clinical Quality Management Plan, Work Plan, Policies and Procedures and Desk Procedures.
• Assists staff in identifying and conducting focused reviews.
• Assists staff in monitoring quality improvement activities.
• Performs other duties as assigned.
• Regular and reliable attendance is required.

Competencies

Coaching / Training / Mentoring: Actively foster actions required for desired business outcomes through ongoing constructive feedback.

Communication / People Skills: Ability to influence or persuade others under positive or negative circumstances; adapt to different styles; listen critically; collaborate.

Computer Literacy: Ability to function in a multi-system Microsoft environment using Word, Outlook, TriWest Intranet, the Internet, and department software applications.

Delegation Skills: Provide clear performance expectations for projects and ensure adequate access to resources for completion.

Independent Thinking / Self-Initiative: Critical thinkers with ability to focus on things which matter most to achieving outcomes; commitment to task to produce outcomes without direction and to find necessary resources.

High Intensity Environment: Ability to function in a fast-paced environment with multiple activities occurring simultaneously while maintaining focus and control of workflow.

Leadership: Successfully manage different styles of employees; provide clear direction and effective coaching.

Multi-Tasking / Time Management: Prioritize and manage actions to meet changing deadlines and requirements within a high volume, high stress environment.

Problem Solving / Analysis: Ability to solve problems through systematic analysis of processes with sound judgment; has a realistic understanding of relevant issues.

Team-Building / Team Player: Influence the actions and opinions of others in a positive direction and build group commitment.

Technical Skills: Proficient with Microsoft Word, Excel, PowerPoint, and Outlook; comprehensive knowledge of research methodology; proficient applying appropriate data analysis processes; knowledge of managed care principles and methods; knowledge in the application of clinical criteria; knowledge of preventive and chronic disease measurements and outcomes (e.g.HEDIS); proficient in use of electronic health record or systems.

Working Conditions

Working Conditions:

• Works within a standard office environment, with minimal travel
• Ability to use a computer and sit for prolonged periods
• Department of Defense security clearance required

Company Overview

Taking Care of Our Nation's Heroes.

It's Who We Are. It's What We Do.

Do you have a passion for serving those who served?

Join the TriWest Healthcare Alliance Team! We're On a Mission to Serve®!

Our job is to make sure that America's heroes get connected to health care in the community.

At TriWest Healthcare Alliance, we've proudly been on that important mission since 1996.

Benefits

We're more than just a health care company. We're passionate about serving others! We believe in rewarding loyal, hard-working people who are willing to learn as they grow. TriWest Healthcare Alliance values teamwork. Join our team, fulfill your responsibilities, and you may also be considered for frequent pay raises, overtime opportunities to earn even more, recognition and reward programs, and much more. Of course, we also offer a comprehensive and progressive compensation and benefits package that includes:

• Medical, Dental and Vision Coverage
• Generous paid time off
• 401(k) Retirement Savings Plan (with matching)
• Short-term and long-term disability, basic life, and accidental death and dismemberment insurance
• Tuition reimbursement
• Paid volunteer time

Equal Employment Opportunity

TriWest Healthcare Alliance is an equal employment opportunity employer. We are proud to have an inclusive work environment and know that a diverse team is a strength that will drive our success. To that end, TriWest strives to create an inclusive environment that cultivates and supports diversity at every organizational level, including hiring and retaining a diverse workforce, and we highly encourages candidates from all backgrounds to apply. Applicants are considered for positions without discrimination on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability or any other consideration made unlawful by applicable federal, state, or local laws.