Quality Management Manager

DELTA DENTAL OF CALIFORNIA, a proven leader in the healthcare industry, is the state?s largest dental health carrier.  Together, the holding company members represent one of the largest dental benefits systems in the country, with 21 million enrollees.  At this time, PMI, an affiliate of Delta Dental has an opening for a Manager, Quality Management.

 

PURPOSE

 

To provide leadership and manage the staff and departmental activities of the Quality Management department (QM) in Cerritos. To ensure the efficient operations and adherence to organizational, state and federal mandated standards and guidelines for resolution and reporting of quality assurance issues, delegated duties, and departmental and divisional goals and objectives.  Oversee the process of implementing Enterprise QM consistency in the Cerritos location.

 

FUNCTIONS

 

1) Provide leadership, organize and manage distribution of workflow for staff supervisors and administrator. Maintain applicable department records. Direct and implement department policies and procedures to ensure performance levels are met. Oversee completion of monthly department reports, quarterly and annual group service and performance guarantee reports. Supervise completion of applicable state regulatory reporting. Plan budget and monitor department?s expenditures. Set departmental goals and objectives with staff, Manager and Director.  Travel to other Enterprise locations as necessary to coordinate QM activities.

 

2) Communicate with staff at regular meetings to impart departmental policies and procedure changes. Implement new policies and procedures. Update staff on status of applicable projects. Effectively communicate with internal and external customers verbally and in writing. Participate in divisional meetings and provide input as it relates to the department?s quality assurance program.

 

3) Monitor provider delivery of care grievance trends and participate in recommendations for course of corrective action. Assist Special Investigative Unit (SIU) with investigation of division?s suspected provider non-compliance with policies and procedures related to fees.

 

4) Interview, select, develop and evaluate the performance of assigned personnel. Work with appropriate divisional and staff to coordinate activities and resources within the enterprise to obtain consistent, high quality performance results. Evaluate the performance of department personnel.

 

GENERAL REQUIREMENTS AND/OR MINIMUM EDUCATION REQUIREMENTS

 

? 5+ years managerial experience, including coaching, staffing, recruiting and training.

? 4+ years of managed care experience.

? Knowledge of state and federal regulatory guidelines.

? Must have excellent analytical skills and problem solving skills.

? Excellent oral and written communication skills.

? Must have ability to assess operational conditions, workflow and make recommendations for maintaining/improving efficiency.

? Organizational and administrative skills to coordinate department activities.

? Proficiency in WORD and EXCEL software.

? Ability to manage multiple tasks and handle stressful situations.

? Must possess valid California driving license.

? Ability to maintain confidentiality.

? Ability to travel by air to any of the Enterprise locations

 



YOU CAN?T BEAT OUR BENEFITS!!  We offer competitive pay and a company paid benefits package. 

 

TO APPLY:on line at :  www.deltadentalca.org and click on jobs 

 

 

In connection with your application for employment with Delta Dental of California and its? related companies, please note that any offer of employment made to any applicant will be contingent upon the satisfactory results of a background check. Such background check may include, but is not limited to, an investigation of credit worthiness, a check of references, employment and education verification, a check of criminal records and/or any other investigations as permitted by law.

 

NO PHONE CALLS PLEASE We are an Equal Opportunity Employer, M/F/D/V.