VP of Quality Management
VP of Quality Management
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Job Description
Overview
The Vice President (VP) of Quality Management (QM) provides strategic management of Sonrava Healths Quality Management Department from an administrative systems and operations perspective. The Department has a Chief Dental Director and team of experienced dentists in charge of dental policy and decision making. This role involves leading the design implementation and continuous improvement of quality management systems as well as facilitating the development of programs and processes that meet regulatory requirements.
The VP will oversee Quality Managements business practices operations and systems management (not clinical). Primary responsibilities will include overseeing overall operations staffing business practices systems and reporting in order to ensure work processes are achieved in an efficient and effective manner. Strong knowledge of workflow technology systems data reporting and analytics is required.
.This role involves leading the design implementation and continuous improvement of quality management systems as well as facilitating the development of programs and processes that meet regulatory requirements.
Responsibilities
- Lead the Quality Management Department including the Quality Program Patient Relations Team and Credentialing functions of Western Dental Plan a licensed Knox-Keene Act Health Plan regulated by the Department of Managed Health Care (DMHC) providing dental insurance to its members.
- Partner with Chief Dental Officer and Dental Director to support the Quality Program with the following committees: Clinical Review Committee Peer Review Committee Quality Improvement Committee Grievance Committee and Credentialing Committee.
- Manage the Patient Relations Team to resolve all patient complaints submitted to corporate including formal grievances submitted by Plan Members within required time frames as well as record requests from Payors.
- Provide oversight for the Credentialing Program for all Staff Model (in-house) and IPA (external network) providers ensuring all providers meet credentialing standards and abide by the Plans policies to successfully achieve and uphold Delegated Credentialing arrangements with 20 payors.
- Maintain compliance via quarterly and annual filings and assist with audits and other requests from the Department of Managed Health Care or any licensed health care agency.
- Collaborate with Payor Relations Legal & Regulatory Affairs and Operations to achieve performance guarantees.
Qualifications
- Bachelors Degree required
- 3 years experience in management healthcare or quality
- Excellent verbal and written communications skills
- Customer service skills
- Dental experience preferred
- Familiar with NCQA (National Committee for Quality Assurance) standards
- CADP (California Association of Dental Plans) Procedural Quality Assurance Consultant can be obtained post-hire
Required Experience:
Exec
Employment Type
Full-Time
