Job #: 2736
Title: Quality Control Manager
The Quality Control (QC) Manager of MLTC is responsible for supporting the day-to-day functions of the MLTC Plan. He/she will manage MLTC’s quality control & quality improvement activities and initiatives, including overseeing the MLTC Quality Analyst. He/she will analyze performance and recommend improvement initiatives and/or corrective actions strategies. The QC Manager will oversee the quality of assessments, care plans and the care planning processes. The Quality Control Manager will be responsible for developing, implementing, and evaluating MLTC performance improvement activities including, but not limited to, analyzing data to identify performance trends; prioritizing and recommending improvements and coaching staff to achieve better performance. The QC Manager will play a role in ensuring compliance with all State and Federal contractual requirements regarding quality management.
The QC Manager will anticipate and resolve complex issues and ensure accurate and quality record keeping. The QC Manager will work closely with the Medical Management Quality Management department as well to ensure that QM staff have access to the MLTC records and information they need. In addition to the day-to-day responsibilities, the Quality Control Manager will work in conjunction with the Director of MLTC-PCS on a variety of critical tasks.
· Responsible for creating the business processes to ensure high quality and timely assessments and care plans
· Oversee the MLTC Analyst who will report to the QC Manager
· Responsible for identifying opportunities for performance improvement in both clinical and operational areas e.g., preventing falls, reducing readmissions, ensuring timely delivery of DME
· Manage the annual MLTC performance improvement project (PIP) including project focus, metrics development, tracking, and reporting.
· Work with IPRO to ensure timely reviews of interim and year-end reports
· Develop and implement on-going staff trainings necessary for improving the timeliness and accuracy of assessment, tasking tools, and care plans
· Oversee the implementation of corrective actions related to internal and external audit findings
· Identifying data resource needs and work with other departments (e.g., IT, Analytics, QM) to provide visibility for tracking and monitoring purposes
· Use the principles of continuous quality and performance improvement to monitor functions and drive organizational improvements in processes.
· Perform periodic performance reviews and targeted audits as determined by the leadership and performance trends.
· Work with Regulatory and compliance to resolve and respond to NYSDOH complaints.
· Work with Quality Management to coordinate member outreach efforts to align resourcing and avoid duplication
· Follow-up to ensure corrective actions for regulatory issues, compliance, or deficiencies identified in patient complaints/incidents and NYSDOH complaints were implemented effectively.
· Regularly conducts audits of patient/member case records, and shares findings with team leads and staff members
· Develops forms, record abstracts, reports, and other tools used to implement concurrent and retrospective patient/member case review, including the design, testing and evaluation of the review methodology.
· Keeps informed of the latest internal and external issues and trends in utilization and quality management.
· Develop standards of staff performance and oversight to ensure performance indicator’s and program requirements are being met.
· Prepare data and written reports or materials for meetings and as required or requested by leadership.
· Evaluates and assesses staff on an on-going basis, offering oral and written counseling as deemed required.
· Conducts departmental meetings and in-services associated with the implementation of new policies and procedures specific to MLTC.
· Performs other duties as directed and as necessary.
· Registered Nurse with a current licensure in NYS. Bachelor’s Degree required.
· A minimum of three years experience in a MCO setting, preferably with MLTC
· Minimum of three years managerial experience.
· Excellent communication, written and analytical skills.
· Knowledge of computers and healthcare information systems.
· Highly organized skills required.
· Ability to work in a fast pace environments and technical clinical expertise required.