DescriptionQuality ManagerAre you an experienced Quality Manager looking for a new challenge? Do you value care management and quality improvement?Are you motivated, energetic, and excited to become part of the Kepro team?If so, you might be our next new team member!Note: This is a fully remote position, east coast or ability to easily work east coast hours required.Who We NeedThe Quality Manager is responsible for developing, implementing, and monitoring quality and performance improvement activities for the Department.Why us?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.People Focused. Mission Driven. Shape the future of healthcare with us. We are mission driven to improve lives through healthcare quality and clinical expertise.We do this through our people.At Kepro, you can do meaningful work that makes a real difference for the lives of individuals across the country. We are an organization that cares deeply about our employees and we provide the training and support to do the best work of your career.Benefits are a key component of your rewards package at Kepro. These benefits are designed to provide you and your family additional protection, security, and support for both your career and your life away from work. They are comprehensive and fit a variety of needs and situations. Our benefits include comprehensive health plans, paid time off, retirement savings, corporate wellness, educational assistance, corporate discounts and more.What You'll DoLeads and facilitates all Quality and Performance Improvement (QPI) activities, relative to KEPRO's support of the United Mine Workers of America Health and Retirement Funds (UMWA Funds) account.Provides QPI coaching to managers and KEPRO staffEnsures the implementation of key performance indicators and maintains systems for tracking, reporting and improving performance.Assists operational leadership in developing benchmarks for quality measures and outcomes over time and across programs.Facilitates electronic access to KEPRO and the UMWA Funds operations staff to current and archived policies, procedures, job aids, letters, reports, committee agendas and minutes. Responsible for ensuring all are updated as changes occur or at least annually.Ensures the promotion of awareness of customer requirements (Service Level Agreements) throughout the operation.Supports and participates in existing CQI activities, quality/outcome studies and the development of cutting-edge innovative programsLeads the Local Quality Improvement Committee (LQIC) and participates in KEPRO's Clinical Practice Oversight Committee (CPOC).Supports quality of care reviews, investigates and assists in resolution of beneficiary grievances or complaints about employees.Monitors to ensure that KEPRO staff have appropriate credentials and training commensurate with their job description. Discrepancies are communicated to applicable leaders.Conducts random audits of Utilization and Case Management cases and reviews manager's audit results to confirm compliance with URAC, Medicare and other regulatory documentation requirements and specified quality indicators to identify opportunities for process improvement. Identifies areas of potential risk associated with the findings.Documents quality metrics in corporate database; identifies positive and negative trends; shares findings with department leadership.Initiates, distributes and summarizes results of beneficiary satisfaction surveys, and provides comparison to designated quality of service performance indicators.Reviews, evaluates and reports critical incidents to corporate compliance (ie. data/ HIPAA breaches, etc.) which may have immediate negative implications for the Company and assists with the formulation of a plan of action for handling the incident/issue. Executes CQI plans to ensure they meet current and future business requirements (eg, best practices, quality, work efficiencies, regulatory requirements, & new program introductions).Participates in preparing and submitting quarterly and annual quality reports and/or deliverables to the Funds staff and identifying patterns and trends in clinical case and utilization management performance and outcomes. Responsible for maintaining the Department's Quality Management Plan. 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.QualificationsWhat you'll need:Bachelor Degree in Nursing is required. Formal training or certification in quality desired (CPHQ, ISO, Six Sigma)ExperienceMinimum of 3 to 5 years of management experience in a health-related field preferred. Quality management and/or compliance experience, required. Experience identifying organizational needs and recommending the appropriate improvements.Knowledge of performance improvement strategies, principles, methodologies, techniques and data analysis Ability to take initiative, provide leadership, maintain confidentiality, meet deadlines and work in a team environment.In depth knowledge of CQI tools, methods and techniques such as Six Sigma. Excellent grasp and understanding of SPC (Statistical Process Control). 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.Knowledgeable and skilled in applying Medicare criteria, MCG, and contract policy requirements.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).Knowledge, Skills, AbilitiesThank You!We know your time is valuable and we thank you in advance for applying for this position. Due to the high volume of applicants we receive, only those who are chosen to advance in our interview process will be contacted. We sincerely appreciate your interest in Kepro and invite you to apply to future openings that may be of interest. Best of luck in your search!~ The Kepro Talent Acquisition TeamMental And Physical RequirementsThe 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.EOE AA M/F/Vet/DisabilityKepro is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.