Moda Health. Healthcare from your head to your toes.

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Quality Programs Manager
Job Title
Quality Programs Manager
Duration
Open Until Filled
Location
Portland,  OR 97204
Other Location
Job Class: 215.0
Description

Let’s do great things, together
 
Founded in Oregon in 1955, Moda is proud to be a company of real people committed to quality. Today, like then, we’re focused on building a better future for healthcare. That starts by offering outstanding coverage to our members, compassionate support to our community and comprehensive benefits to our employees. It keeps going by connecting with neighbors to create healthy spaces and places, together. 

We are seeking a Manager in our Quality Programs team in our Healthcare Services Department. This position will manage regulatory/compliance, accreditation, and quality improvement activities for all ModaHealth lines of business and Moda Inc. subsidiaries as needed.

Primary Functions:
1.    Manages onsite quality reviews of OHP (Medicaid) plan by the State of Oregon for both Medical and Dental plans.  
2.    Obtains and prepares information requested by oversight bodies and resolves any deficiencies.
3.    Manages all activities associated with the NCQA accreditation process.
4.    Provides oversight on HEDIS production and submission processes.
5.    Provide oversight for quality improvement activities.
6.    Provide oversight for all delegation activities.
7.    Organizes and leads multi-disciplinary committees, councils, task forces and related.
8.    Recommend policy and/or process changes to ensure ModaHealth’s Healthcare Services division meets all applicable quality regulatory requirements.  
9.    Prepares reports and plans to ensure compliance with federal, state and local Healthcare Services – related requirements and to aid in problem identification and decision-making.  
10.    Performs other duties as assigned

 

Are you ready to be a betterist?
 
If you’re ready to make a difference that matters, we want to hear from you. Because it’s time to discover what’s possible.
 
Together, we can be more. We can be better.
 
Moda Health seeks to allow equal employment opportunities for all qualified persons without regard to race, religion, color, age, sex, sexual orientation, national origin, marital status, disability, veteran status or any other status protected by law.

EOE/M/F/D/V

Required Skills
1. Bachelor’s degree in health and or business-related field is required; past clinical experience preferred
2. 2-4 years’ experience in continuous quality improvement processes, data analysis, NCQA or JCAHO accreditation, HEDIS reporting, or related quality assurance/ regulatory activities.
3. Previous supervisory experience is strongly preferred.
4. Excellent organizational, project management, problem-solving skills
5. Consultative skills with the ability to successfully construct solutions.
6. Strong initiative and drive to identify opportunities for improvement and build stakeholder support for solutions
7. Open communicator with strong written and verbal communications skills.
8. Proficient with Microsoft Office applications.
9. Ability to maintain confidentiality and project a professional business image.
10. Experience in working collaboratively and cross-functionally within an organization in a matrixed environment.
Optional Skills
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