Exl Service

  • Manager of Quality Improvement, Accreditation and Training

    Job Location US-FL-Tampa
    ID
    2018-5502
    Group
    Operations Management (+HI)
    Type
    Regular Full-Time
  • Overview

    EXL (NASDAQ: EXLS) is a leading operations management and analytics company that designs and enables agile, customer-centric operating models to help clients improve their revenue growth and profitability. Our delivery model provides market-leading business outcomes using EXL’s proprietary Business EXLerator Framework™, cutting-edge analytics, digital transformation and domain expertise. At EXL, we look deeper to help companies improve global operations, enhance data-driven insights, increase customer satisfaction, and manage risk and compliance. EXL serves the insurance, healthcare, banking and financial services, utilities, travel, transportation and logistics industries. Headquartered in New York, New York, EXL has more than 26,000 professionals in locations throughout the United States, Europe, Asia (primarily India and Philippines), South America, Australia and South Africa. For more information, visit www.exlservice.com.

     

     

    The Manager of Quality Improvement, Accreditation and Training (Manager) is responsible for the development and implementation of an organization-wide quality improvement program that will effectively monitor, improve and advance the quality of care and service goals of Health Integrated and its customers. This will include monitoring and ensuring compliance with all accreditation and regulatory requirements. The Manager will be responsible for the oversight of the HI training programs, including the onboarding, job readiness and skill building of all HI staff. The Manager will collaborate with EXL training and quality resources to ensure service excellence through continuous improvement. The Manager oversees the organizational Quality Improvement Program, including the day-to-day clinical and service quality improvement initiatives throughout the Health Integrated organization. They support the development, coordination, implementation and evaluation of continuous quality improvement and organizational excellence in areas of quality of care and service, compliance, key performance indicators, and provider and member satisfaction.

     

     

     

     

    Responsibilities


    • Assists the SAVP of Care Management Operations with advancing the QI program objectives by facilitating QI initiatives with department lead persons
    • Actively participates in client operational meetings and supports the QI management team in developing internal processes and initiatives in support of client objectives
    • Assists with the development, monitoring and resolution of corrective action plans in response to clients, accreditation agencies or regulatory bodies
    • Identifies, designs and implements quality improvement initiatives that will impact member care and service quality, including member safety initiatives
    • Assists the SAVP of Care Management Operations with coordinating the activities of the Health Integrated Quality Improvement Committee (HIQIC)
    • Actively participates on the HIQIC by providing regular reports on the status of QI activities and overseeing the reporting of QI staff
    • Monitors and identifies changes in or new accreditation requirements and communicates those requirements to appropriate individuals/departments
    • Integrates new and revised accreditation standards into Health Integrated policies, procedures and processes; and facilitates organization-wide accreditation preparations
    • Utilizes root cause analysis skills in data analysis to understand significant and problematic issues; develops and implements improvement plans in collaboration with department leads
    • Evaluates QI initiatives against established targets and goals to identify trends, barriers, opportunities and improvement actions
    • Facilitates the annual member and practitioner satisfaction survey process, including but not limited to: data analysis, action plan development, client report preparation, and the continual assessment to streamline and improve this process
    • Assists in advancing the operational objectives of quality and process improvement by organizing the necessary teams, utilizing the appropriate tools and process measures to improve member clinical and service goals
    • Conducts the Annual Evaluation of the effectiveness of the Quality Improvement Program and provides results to internal and external clients.
    • Oversees the development and implementation of the annual Quality Improvement Program Description, and Corporate QI Work Plan
    • In collaboration with Corporate Compliance and Client Services, oversees the client pre-delegation and ongoing delegation assessments to ensure compliance with accreditation, regulatory and client requirements
    • Manages the performance of Training staff: including hiring, managing, supervising, mentoring, dismissing or separation and the professional development of the staff
    • Oversees the development and delivery of training curriculum for all Care Management Operations departments through multiple methods to ensure efficient and effective training
    • Conducts ongoing training needs assessment based on audit results, self-reported gaps in knowledge, reports of non-compliance, or based on feedback from internal or external customers
    • Continuously evaluates the efficiency and effectiveness of the training programs, and implements changes in the content and delivery methods as needed
    • Performs other duties as indicated by the SAVP of Care Management Operations

    Customer Services-Internal:
    • Supports a positive working environment
    • Identifies and resolves potential personnel/peer problems and issues proactively, readily utilizing the SVP Quality Improvement and Corporate Governance as a resource
    • Communicates to SVP Quality Improvement and Corporate Governance all problems, issues and/or concerns as they arise
    • Maintains a courteous and professional attitude when working with all Health Integrated staff members and the management team
    • Functions as role model and healthcare leader when working with all Health Integrated and EXL staff
    • Participates in team meetings as designated
    Customer Service-External:
    • Maintains a professional attitude/image when communicating with Health Integrated and EXL visitors, customers, and/or clients
    • Collaborates with Health Integrated clients/customers/audit/surveyors in a professional manner
    • Reports all quality improvement data/issues to Health Integrated’s clients in a timely manner
    • Supports/maintains positive relations with Health Integrated clients/customers

     

     

     

    Qualifications

    Qualifications:

    • Proficiency in software applications including: Outlook, MS Word, MS Excel, and MS Power Point
    • Current broad-based expertise in managed care, quality improvement processes, URAC and NCQA accreditation standards, and state and federal guidelines in healthcare
    • Ability to interact effectively with physicians, operational and clinical staff, peers, and other business leaders
    • Ability to develop and facilitate interdepartmental teams within the organization
    • Excellent verbal and written communication skills; ability to speak clearly and concisely, conveying complex or technical information in a manner that others can understand
    • Effective problem-solving skills with the ability to systematically analyze problems draw appropriate conclusions and develop relevant courses of action
    • Strong statistical and analytical skills with knowledge of CQI concepts, implementation and evaluation
    • Hands-on experience with writing and implementing policies and procedures to support QI processes including accreditation and/or regulatory compliance

      

    Education:

    • Licensed professional in a healthcare field with current unrestricted license (RN, LCSW, LMHC)
    • Associates degree or equivalent work experience
    • Certified Professional in Health Care Quality (CPHQ) or other advanced certification preferred
    • Five to ten years of extensive experience with demonstrated competency in health care quality may substitute for the educational requirements
    • High School Diploma required

     

    Work Experience Requirements:
    • At least10 years of experience in health care delivery, with management experience preferred
    • At least 3-5 years conducting oversight of compliance and quality performance for a health plan or delegated vendor
    • Working knowledge of NCQA, URAC & CMS standards and regulations; Successful accreditation experience required
    • Behavioral Health experience desired

     

    EEO Statement

    EEO/Minorities/Females/Vets/Disabilities

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