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Program Quality Manager

Job Description

KEPRO is a rapidly growing national quality improvement and care management organization. We work to ensure that over 20 million people receive the right care, at the right time, in the right setting. KEPRO is seeking resumes for a highly experienced professional.

Accountabilities 

  • Facilitates all QA activities, provides continuous improvement consulting services to internal customers and employs knowledge of performance improvement strategies, principles, methodology, techniques and data analysis.
  • Ensures the implementation of key performance indicators and maintains systems for tracking, reporting and improving performance.
  • Ensures the promotion of awareness of customer requirements throughout the operation.
  • Reviews audit results and identify the severity of audit findings or the risk associated with the findings.
  • Reviews and evaluate reported crisis (i.e., highly-urgent service related problem with immediate negative implications for the Company) and assists to formulate a plan of action for handling the incident/issues based on area of expertise/responsibility.
  • Execute QA plans to ensure they meet current and future business requirements (e.g., best practices, quality, volume and product growth, regulatory requirements, & new product introductions).
  • Assists in preparing and submitting reports and/or deliverables timely as required.
  • Other duties as assigned.

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

Supervisory Responsibility 

  • Quality oversight of licensed clinicians completing PASRR evaluations of individuals with suspected or confirmed mental illness to determine the presence of a Serious Mental Illness (SMI), as defined by 42 CFR 483.102(b)(1), Intellectual Disability or Other Related Conditions (ID/RC) as defined by 42 CFR 483.102(b)(3) and F.A.C. 59G-1.040(2)(b).
  • Quality initiatives to meet contract compliance and all workflows to remain within required turnaround times.

Qualifications 

  • BA/BS minimum, Master’s degree preferred.
  • Florida Licensure required (LCSW, LMHC, RN, clinical psychologist)
  • Formal training or certification in quality preferred. (CPHQ, ISO, Six Sigma)

Knowledge, Skills, Abilities 

  • Knowledge of Federal Regulation 42 CFR, Chapter 483
  • Knowledge of Florida Administrative Code 59G-1.040
  • Knowledge of psychiatric disorders as defined by the most current Diagnostic and Statistical Manual in use.
  • Knowledge of standards of practice related to determination of Level of Care.
  • Knowledge of standards of practice related to mental health, intellectual and developmental disabilities, geriatric, and other disorders typically requiring long term care placement.
  • Ability to take initiative, provide leadership, maintain confidentiality, meet deadlines and work in a team environment.
  • Knowledge of CQI tools, methods and techniques.
  • Knowledge of URAC, NCQA &/or ISO background a plus.
  • Analytical skills must be highly developed with an ability to objectively evaluate data and perform statistical analysis.
  • Excellent communication (verbal and written), organizational, presentation, and interpersonal skills required.
  • Ability to prioritize and manage multiple assignments.
  • Knowledge of Microsoft software applications (Word, Excel, PowerPoint, Access).

Experience 

  • Minimum of 3 to 5 years of management or quality management experience in a health-related field.
  • Quality management and/or compliance experience, required.
  • Experience identifying organizational needs and recommending the appropriate improvements.

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.

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information.

Job Requirements

See job description

Job Snapshot

Location US-FL-Tallahassee
Employment Type Full-Time
Pay Type Year
Pay Rate N/A
Store Type Health Care
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Company Overview

KEPRO

Evolving intelligence with timeless values.Since 1985, KEPRO has helped over 1 billion members lead healthier lives through clinical expertise, integrity and compassion. Our values are promises we keep every day. And why we keep growing with our clients. Learn More

Contact Information

US-FL-Tallahassee
Snapshot
KEPRO
Company:
US-FL-Tallahassee
Location:
Full-Time
Employment Type:
Year
Pay Type:
N/A
Pay Rate:
Health Care
Store Type:

Job Description

KEPRO is a rapidly growing national quality improvement and care management organization. We work to ensure that over 20 million people receive the right care, at the right time, in the right setting. KEPRO is seeking resumes for a highly experienced professional.

Accountabilities 

  • Facilitates all QA activities, provides continuous improvement consulting services to internal customers and employs knowledge of performance improvement strategies, principles, methodology, techniques and data analysis.
  • Ensures the implementation of key performance indicators and maintains systems for tracking, reporting and improving performance.
  • Ensures the promotion of awareness of customer requirements throughout the operation.
  • Reviews audit results and identify the severity of audit findings or the risk associated with the findings.
  • Reviews and evaluate reported crisis (i.e., highly-urgent service related problem with immediate negative implications for the Company) and assists to formulate a plan of action for handling the incident/issues based on area of expertise/responsibility.
  • Execute QA plans to ensure they meet current and future business requirements (e.g., best practices, quality, volume and product growth, regulatory requirements, & new product introductions).
  • Assists in preparing and submitting reports and/or deliverables timely as required.
  • Other duties as assigned.

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

Supervisory Responsibility 

  • Quality oversight of licensed clinicians completing PASRR evaluations of individuals with suspected or confirmed mental illness to determine the presence of a Serious Mental Illness (SMI), as defined by 42 CFR 483.102(b)(1), Intellectual Disability or Other Related Conditions (ID/RC) as defined by 42 CFR 483.102(b)(3) and F.A.C. 59G-1.040(2)(b).
  • Quality initiatives to meet contract compliance and all workflows to remain within required turnaround times.

Qualifications 

  • BA/BS minimum, Master’s degree preferred.
  • Florida Licensure required (LCSW, LMHC, RN, clinical psychologist)
  • Formal training or certification in quality preferred. (CPHQ, ISO, Six Sigma)

Knowledge, Skills, Abilities 

  • Knowledge of Federal Regulation 42 CFR, Chapter 483
  • Knowledge of Florida Administrative Code 59G-1.040
  • Knowledge of psychiatric disorders as defined by the most current Diagnostic and Statistical Manual in use.
  • Knowledge of standards of practice related to determination of Level of Care.
  • Knowledge of standards of practice related to mental health, intellectual and developmental disabilities, geriatric, and other disorders typically requiring long term care placement.
  • Ability to take initiative, provide leadership, maintain confidentiality, meet deadlines and work in a team environment.
  • Knowledge of CQI tools, methods and techniques.
  • Knowledge of URAC, NCQA &/or ISO background a plus.
  • Analytical skills must be highly developed with an ability to objectively evaluate data and perform statistical analysis.
  • Excellent communication (verbal and written), organizational, presentation, and interpersonal skills required.
  • Ability to prioritize and manage multiple assignments.
  • Knowledge of Microsoft software applications (Word, Excel, PowerPoint, Access).

Experience 

  • Minimum of 3 to 5 years of management or quality management experience in a health-related field.
  • Quality management and/or compliance experience, required.
  • Experience identifying organizational needs and recommending the appropriate improvements.

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.

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information.

Job Requirements

See job description

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