Senior Quality Improvement Project Manager in New Haven, CT

The Senior Quality Improvement Project Manager supports the development and implementation of quality improvement interventions and audits and assists in resolving deficiencies that impact plan compliance to regulatory and accreditation standards. The incumbent drives key quality improvement projects requiring the expertise to work efficiently in a matrix environment in order to receive needed data that reflects the overall health of the plan.• Establishes and/or revises existing WellCare policies and procedures necessary for successful implementation of the Quality Improvement (QI) Program.• Pursues methods to ensure receipt of relevant data, as required for accurate trending of various QI work plan metrics.• Analyzes key plan metrics, such as top diagnoses, clinical procedures, and operational performance, to enable the development of sound and valid recommendations regarding and prioritization of clinical and service improvement initiatives.• Works with QI Sr. Director to convene various QI committees and work groups, set agenda to drive desired meeting outcomes (based on contract and accreditation qualifications), and ensure proper recording of committee activities.• Performs various quality department functions and processes, such as quality of care complaint/adverse event review and assessment of medical record review results and recommend actions to address any identified improvement opportunities.• Manages and monitors clinical quality studies to include receipt and analysis of trended data, assessment of national benchmarks as available, development of improvement recommendations (to include ROI and best practice interventions as appropriate), presentation to senior leadership, implementation of plan, and evaluation for desired result.• Performs activities to comply with annual HEDIS data collection and analysis, preparing recommendations to increase rates as appropriate.Listing originally posted at http