Perform duties to oversee and manage the functions of the quality improvement program for the assigned state, providing support to staff and communicating with department and plan administrative staff to facilitate daily department functions.

Leadership: Manage and coordinate activities of the assigned work function and/or department. Assign or delegate responsibilities for specific work or functional activities. Give work directions, resolve problems, prepare schedules and set performance expectations and deadlines to ensure timely completion of work. Coordinate activities of assigned work function and/or department with related activities of other work functions and/or departments to ensure efficiency and economy. Report Preparation: Review and analyze reports, records and directives, and confer with staff to obtain data required for planning work function activities, such as new projects, status of work in progress, and problems encountered. Also to verify data to be submitted in accordance with state Medicaid program requirements and to ensure compliance with Company, Federal, State, Health Plan Employer Data and Information Set (HEDIS), National Committee on Quality Assurance (NCQA) and/or Joint Commission on Accreditation of Healthcare Organization (JCAHO) standards. Prepare reports and records on work function activities for management, using computer. Methods and Procedures: Evaluate current procedures and practices for accomplishing the assigned work function’s objectives to develop and implement improved procedures and practices and to ensure compliance with Company, Federal, State, National Committee on Quality Assurance (NCQA) and/or Joint Commission on Accreditation of Healthcare Organization (JCAHO) standards. Customer Service: Collaborate with appropriate departments to document, investigate and resolve formal/informal complaints and appeals in accordance with Company and State policies, procedures and requirements Annual Budgeting: Monitor and analyze costs and participate in the preparation of the budget, using computer. People Development: Initiate and participate in the hiring of staff, promotions, discharges and transfers. Train and supervise staff. Typical Duties: Participate in, attend and plan/coordinate, as necessary, staff, departmental, committee, sub-committee, State and other activities, meetings and seminars.

Tags: Nurse Manager

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