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Quality Improvement Manager

Date:  Jul 2, 2024

Any city, OH, US, 99999

Req ID:  21089


As a ​Quality Improvement Manager at Gainwell, you can contribute your skills as we harness the power of technology to help our clients improve the health and well-being of the members they serve — a community’s most vulnerable. Connect your passion with purpose, teaming with people who thrive on finding innovative solutions to some of healthcare’s biggest challenges. Here are the details on this position.

Your role in our mission

•    Provides quality improvement expertise for the organization. 

•    Directs the identification of and fosters designs for quality improvement activities across the product delivery spectrum including internal QI projects and population health programs. 

•    Advocates for the value of the SPBM’s quality improvement agenda to executive leadership and internal/external stakeholders. 

•    Works to embed quality improvement standards of equity across the organization so that health equity becomes part of the practice, process, action, innovation, and organizational performance and outcomes.

•    Engages with ODM staff and the SPBM QI Director to ensure alignment of SPBM quality improvement strategies.

•    Communicates SPBM quality improvement strategies to the SPBM QI Director to aid in the development and management of the SPBM’s quality assessment and performance improvement (QAPI) program.

•    Coordinates with ODM-contracted managed care entities to ensure alignment of quality improvement initiatives such as but not limited to quality improvement and performance projects as defined by ODM.

•    Acts in a supervisory role for direct reports to assign work, monitor progress and evaluate overall team performance.

•    Collaborates with the QI Director to ensure fulfillment of relevant model agreement requirements and overall strategic objectives. 

What we're looking for

•    Supervises functional areas or department account leads on smaller sized or segment of larger accounts to ensure that business solution objectives are met. 

•    Develops demand forecasts with account teams to assist functional areas or departments in planning and delivering end-to-end services.

•    Works with functional areas or departments to interpret and plan projects or workload forecasts. Identifies and oversees resolution of account specific service problems including prioritizing work requests. 

•    Monitors and approves expenditures for accounts in line with the established policies and procedures. Oversees spending for adherence to budget, recommends variances as needed.

•    Works closely with management team, lines of service and clients to help manage complex relationships between delivery and consumer groups to ensure good client relations.

•    Identifies and monitors service improvements to increase customer satisfaction. Supervises and ensures delivery of projects meet client and company expectations and needs.

•    Partners and collaborates with functional areas or departments to integrate new, enhanced, and existing service offerings for accounts. 

•    Recommends and/or initiates the selection and hiring of employees. Trains and evaluates employees to enhance their performance, development, and work product. Addresses performance issues and

makes recommendations for personnel actions. Makes recommendations for salary increases, transfers, and terminations to manager.

Bachelor’s degree in healthcare administration, Public Health, Community and Public Health or equivalent combination of education and work experience.

Required Experience
    • 3 -5 years' experience in healthcare with minimum 2 years' experience in quality improvement, managed care, pharmacy or equivalent experience.

    • Demonstrated solid business writing experience.

    • Demonstrated knowledge of Ohio Medicaid regulations, and guidance   

    • Experience in population health, health services research, health policy, epidemiology, service coordination, ambulatory care, community public health, case or care management, or coordinating care

across multiple settings and with multiple providers 

    • Demonstrated knowledge of health equity and its evaluation is required 

    • Demonstrated understanding of health equity (Social determinates of Health - SDoH)

    • Demonstrated knowledge regarding quality improvement principles and processes 

    • Experience in data collection, data interpretation, evaluating intervention outcomes, identifying issues within a population, and evaluating social determinants of health 

    • Demonstrated leadership ability to drive results as well as lead across the organization through team influence and collaboration 

Preferred Education
    • Master’s degree in public health (MPH), Public Administration (MPA) or equivalent 

Preferred Experience
    • 3-5 years of MCO/PBM pharmacy experience preferred 

    • Experience with data reporting, analysis and/or interpretation.

    • Six Sigma Lean 

    • Quality Improvement in Healthcare Certificate


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