Novato, California
Director of Quality & Care Management Job Opening in Novato, California - Meritage Medical Network (MMN) is a network of 700 primary care and specialist physicians working together to provide quality health care for our patients. Meritage covers three counties: Marin, Sonoma, and Napa. We contract with 7 HMOs and with the Centers for Medicare Services for a Medicare Shared Savings Program. All told, Meritage primary care physicians provide medical services to over nearly half a million residents of the San Francisco North Bay.
Reporting to the VP of Operations and working with other members of the company leadership team, key Physician partners, and third party customers and vendors, this position is responsible for developing, managing and directing the organization?s Quality Assurance and Care Management programs, initiatives, services and clinical and administrative staff.
Establishes guidelines, performance standards, metrics, and monitors compliance for all aspects of Utilization Management, Case/Care Management and Quality programs.
Develops and manages efforts and services that emphasize appropriate admissions and management of ambulatory and inpatient utilization, as well as concurrent and retrospective review of care, and discharge planning to promote a centralized, coordinated, qualitative and efficient interdisciplinary process in the continuum of care.
Is also responsible for compliance of HEDIS, NCQA and other related oversight agencies and audits.
Requirements:
Excellent leadership, interpersonal, negotiating, collaboration and communication skills.
Proficiency in the area of developing, managing, and reporting clinical and business analytics and metrics.
Bachelor?s degree in healthcare related discipline, BSN is a plus.
A minimum of 7 years of current related experience, 5 years of which in managed care operations.
Experience in quality, discharge planning, utilization management, home care, and complex care management preferred.
Demonstrated knowledge of DMHC, Medicare, Medi-Cal, and other local, state, and federal regulations.
Meritage offers a professional work environment where employees are valued. Full-time and part-time employees who work at least 30 hours per week receive a comprehensive benefits package including paid time off and holidays, medical, dental, vision, long term disability (LTD), life insurance, voluntary life insurance option, flexible spending accounts (FSA), employee assistance program (EAP) and a 401(k) retirement plan.
Job Type: Full-time
Job Location:
Novato, CA 94949
Required education:
Bachelor's
|
