• Amerihealth
  • Raleigh, NC
  • Executive Management
  • Full-Time
  • 2500 Holiday Dr

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Job Brief

Director, Quality Management - RN

Your career starts now. We re looking for the next generation of health care leaders.

At AmeriHealth Caritas, we re passionate about helping people get care, stay well and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we d like to hear from you.

Headquartered in Philadelphia, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more about us at www.amerihealthcaritas.com.

AmeriHealth Caritas North Carolina has been awarded a contract to provide a standard benefit plan under the state's new Medicaid managed care program, which will also include long-term services and supports. The program will be launched in two phases the first on Nov. 1, 2019, and the second on Feb. 1, 2020.
The Director, Quality Management is responsible and accountable for the successful, ongoing development, refinement, implementation, measurement, ongoing quality improvement and effectiveness of the Health Plan s, Line of Business, or Product s Quality Management Program. Additionally, the position is responsible and accountable for QAPI program activities and for the ongoing maintenance of the Plan s compliance with state regulations and NCQA/URAC and other appropriate standards for activities related to Quality, Care Management and Utilization Management. This includes credentialing/re-credentialing activity, delegation oversight, quality of care investigations as well as the corresponding inter- and intra-departmental coordination, communication, and education.
  • Works directly with Senior Executives to plan, organize and direct the identification, prioritization and implementation of strategic projects that improve financial, service and clinical outcomes for the Plan, LOB or Product Line.
  • Meets with DHHS and the other MCO s to review quality related initiatives and how those initiatives can be coordinated across the Plans.
  • Provides primary oversight and responsibility for the Plan s, Line of Business or Product Line s Quality and Medical Management Committee structure and support.
  • Provides functional support to the Network Management, Informatics, Information Solutions, Care Coordination, Utilization Management, and Public Affairs departments to integrate Quality Management initiatives and goals with organizational programs.
  • Plays an active role in the dissemination of the Quality Management best practices throughout the AmeriHealth Caritas Family of Companies and assists with new business opportunities and implementation.

Education and Experience:

  • Bachelors degree required, Masters preferred
  • 5 years managed care experience preferred
  • 5 year s managerial experience.
  • 8-10 years of progressively responsible healthcare or clinical experience in a quality management related role
  • Prior URAC or NCQA Accreditation experience
  • Must reside in North Carolina per contractual requirements.
  • An unrestricted certified license (LCSW, RN, MD, DO) in North Carolina is required based on contractual requirements.

Associated topics: design, engineering, manufacture, product, product manager, production, program manager, quality

* The salary listed in the header is an estimate based on salary data for similar jobs in the same area. Salary or compensation data found in the job description is accurate.