Job Title: Manager of Quality Improvement

Target Compensation Range: $90,000-$110,000/year, depending on the level of relevant qualifications and experience.

About Us:

Astiva Health, Inc., located in Orange, CA is a premier healthcare provider specializing in Medicare and HMO services. With a focus on delivering comprehensive care tailored to the needs of our diverse community, we prioritize accessibility, affordability, and quality in all aspects of our services. Join us in our mission to transform healthcare delivery and make a meaningful difference in the lives of our members.

SUMMARY: The Manager of Quality Improvement is responsible for oversight of key medical management functions including: Quality Management, Quality Improvement (QI), Risk Adjustment Factors, and Quality Assurance. This position is a key leader and is accountable in leading the areas assigned to next-level capabilities and operational efficiencies consistent with the strategic plan, goals, and objectives for Astiva.

ESSENTIAL DUTIES AND RESPONSIBILITIES include the following:

• Responsible for leading and collaborating with others on NCQA Accreditation and HEDIS performance.
• Responsible for quality improvement aspects of risk adjustment processes.
• Collaboration with Medicare STARS team to improve overall STARS rating for Medicare products, including HEDIS, CAHPS, HOS. Develop and implement action plans for improvements.
• Oversee provider satisfaction surveys and implement action plans for improvements.
• Research and incorporate best practices into operations.
• Review and implement methods, procedures, new technology tools and processes and foster team concept with internal and external constituencies.
• Present results of improvement efforts and ongoing performance to senior management.
• Formulate and establish policies, operating procedures, and goals in compliance with internal and external guidelines.
• Prepare for all regulatory audits with goals of zero negative findings.
• Regular and consistent attendance
• Other duties as assigned.

EDUCATION and/or EXPERIENCE :

• Bachelor’s degree in Nursing, or related clinical degree or equivalent experience. Master’s degree preferred.
• Minimum of 5 years’ experience in QI management, improvement and healthcare operations.
• High level of expertise in Cozeva preferred.
• Strong understanding of CMS regulations within QI.
• Detailed understanding of quality improvement measures within a health plan, IPA or medical group.
• Excellent communication skills including documentation and presentation.

BENEFITS:

• 401(k)
• Dental Insurance
• Health Insurance
• Life Insurance
• Vision Insurance
• Paid Time Off