KEPRO Director, Quality Management in Scranton, Pennsylvania

Director, Quality ManagementinScranton, PAatKEPRO

Date Posted:4/16/2018

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Job Snapshot

  • Employee Type:

Full-Time

  • Location:

Scranton, PA

  • Job Type:

QA - Quality Control

  • Experience:

5 to 7 years

  • Date Posted:

4/16/2018

Job Description

Since 1985, KEPRO has helped more than 20 million members lead healthier lives through clinical expertise, integrity and compassion. KEPRO was founded by physicians and clinical expertise is at the core of our organization. We are a leading quality improvement and care management organization. We offer innovative and outcomes-focused solutions to reduce the unnecessary use of health care resources and optimize the quality of care for public and commercial clients. KEPRO’s tailored programs maximize members’ quality of life, and realize greater cost savings for members and clients alike. KEPRO is on a journey to transform medical management and to develop customized solutions tailored to our client’s specific business requirements, while improving the quality of life for patients, reducing costs, and achieving return on investments for our clients. Our approach to medical management is holistic and compassionate and is coordinated around a patient’s entire healthcare experience.

Director, Quality

Summary Description

Responsible for overseeing day-to-day operations of the Quality Management Program, including the design, development and oversight of quality monitoring activities.

Accountabilities

  • Plans, coordinates, and directs quality assurance program designed to ensure continuous quality of products consistent with established standards and customer requirements.

  • Oversees and facilitates all QA activities, provides continuous improvement consulting services to internal customers, employs knowledge of performance improvement strategies, principles, methodology, techniques and data analysis.

  • Utilizes measurable indicators and outcome measurements to determine whether the desired organizational results are achieved.

  • Establishes key performance indicators and maintains systems for tracking, reporting and improving performance.

  • Reviews audit results and identify the severity of findings or the risk associated with the findings to ensure the appropriate level of action is taken to eliminate non-conformance.

  • Tracks or follows up on corrective action plans in order to ensure completion of all items in the specified time frame.

  • Review and evaluate reported crisis (i.e., highly-urgent service related problem with immediate negative implications for the Company) and formulate a plan of action for handling the incident/issues based on area of expertise/responsibility.

  • Assists with the activities associated with the implementation and compliance of URAC standards requirements.

The list of accountabilities is not intended to be all-inclusive and may be expanded to include other education- and experience-related duties that management may deem necessary from time to time.

Qualifications

  • Active RN license required.

  • Bachelor’s Degree in related health care discipline is required.

  • Formal training or certification in quality preferred. (CPHQ, ISO, Six Sigma)

  • Master’s degree preferred.

Knowledge, Skills, Abilities (KSA)

  • In depth knowledge of CQI tools, methods and techniques such as Six Sigma, or Lean Manufacturing.

  • Knowledge of URAC, NCQA &/or ISO background a plus.

  • Ability to take initiative, provide leadership, maintain confidentiality, meet deadlines and work in a team environment.

  • Ability to prioritize and manage multiple projects.

  • Excellent grasp and understanding of SPC (Statistical Process Control).

  • Analytical skills must be highly developed with an ability to objectively evaluate data and perform statistical analysis.

  • Knowledgeable and skilled in applying clinical criteria standards such as McKesson’s InterQual, Milliman, or various Medicaid and contract policy requirements.

  • Excellent communication (verbal and written), organizational, presentation, and interpersonal skills required.

  • Knowledge of Microsoft software applications (Word, Excel, PowerPoint, Access).

  • Excellent interpersonal skills required.

Experience

  • Minimum of 5-7 years of management experience in a health-related field.

  • Quality management and/or compliance experience required.

  • Experience identifying organizational needs and recommending the appropriate improvements to increase organizational effectiveness.

Mental and Physical Requirements

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations will be made as required by law in an attempt to enable an individual with a disability to perform the essential functions of this job. While performing the duties of this job, the employee is regularly required to sit for prolonged periods of time; key and/or control objects; interact extensively with internal and external customers; occasionally lift and/or move objects weighing up to 10 pounds; and occasionally travel within the state.

KEPRO offers challenging careers, excellent benefits and opportunities for advancement. For consideration, please submit resume and cover letter with salary requirements. Only those candidates identified for an interview will be contacted. No Phone Calls Please. Visit our website at www.kepro.com for more information on the KEPRO Family of Companies.

EOE AA M/F/Vet/Disability

KEPRO is an E-Verify employer. E-Verify is an internet based system operated by the Department of Homeland Security (DHS) in partnership with the Social Security Administration (SSA) that allows participating employers to electronically verify the employment eligibility of their newly hired employees in the United States.