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Directs organization's activities of strategic planning, evaluation, coordination, and implementation of various managed health care programs (HMO's, PPO's, long-term care). Organizes and develops short- and long-term planning programs to ascertain community and organization's requirements. Typically reports to Hospital Administrator and directs subordinate staff.: Administers fiscal operations such as budget planning and establishing rates for alternative delivery services. Directs activities concerned with contracts for alternate delivery systems. Reviews bids for conformity to contract requirements and determines acceptable bids. Negotiates contract with bidder. Requests or approves amendments to or extensions of contracts. Develops policies and procedures for various activities to assure objectives of hospital, managed care, physicians, care givers and patients are met. Ensures compliance of facilities with all regulations. Ensures that all providers and employees meet and maintain requirements and licenses. Develops and implements methods and procedures for monitoring work activities, such as preparation of records of expenditures, progress reports, etc., in order to inform management of current status of work activities. Recommends measures to improve methods, performance, and quality of service, and suggests changes in working conditions to increase efficiency. May recruit, hire, train staff, evaluate employee performance, and recommend or initiate promotions, transfers, and disciplinary action. Analyzes department budget to identify budget needs and or reductions, and may allocate operating budget's funds. Interprets company policy to employees and enforces safety regulations.

Managed Care Director

Develops and implements strategic, operational, and tactical business plans to meet customer service requirements and optimize financial performance. Maintains and develops relationships with health plans and medical groups. Develops contracting plans and forecasts. : Directs and performs the negotiation of contracts with managed care payers and group purchasing organizations. Monitors existing contract performance. Conducts financial analyses and considers impact of applicable regulatory requirements. Collaborates with senior management and/or multiple decision-makers to conclude sales. Serves as liaison between customer and company personnel on administrative matters. Develops and assists in implementation of referral strategies. Develops and manages the budget. Controls expenses while meeting operational, financial, and service requirements. Recruits, develops, and motivates staff. May lead team of sales/technical/marketing personnel on larger sales efforts.

Managed Care Head

Managed Care Contracting Manager

Responsible for the coordination, evaluation and negotiation of managed care contracts under consideration. This position typically requires five or more years of experience in the negotiation of contracts in a managed care or hospital environment.: Responsible for the coordination, evaluation and negotiation of managed care contracts under consideration. Responsible for the oversight of all contract coordination activities. Represents the organization to the employer community and solicits business. Works with current subscribers to develop additional business opportunities. Coordinates contract negotiation and resolves complex issues. Works closely with physicians in program development and specialist relations. Monitors managed care contract performance and addresses related concerns. Evaluates potential business opportunities and develops innovative approaches that can benefit the organization. Attempts to standardize contracts to ensure effective and efficient implementation. This position typically requires five or more years of experience in the negotiation of contracts in a managed care or hospital environment.

Supervisor Managed Care

Supervises and coordinates the activities of personnel in the managed care department of a healthcare facility to ensure department productivity and quality goals are met. Assists with the analysis of the financial and operational impact of managed care contracts and the maintenance of related databases within the overall structure developed by the Director of Managed Care. Participates in and provides oversight of contract compliance activities and maintains relationships with key health plan contacts. Serves as a liaison to Finance Department regarding managed care related issues.: Hires, schedules, and monitors staff in the Managed Care Department. Ensures employees receive appropriate orientation and training to perform their jobs, including writing and communicating standard operating procedures. Tracks employee time and attendance. Provides financial data to management as well as other reporting concerning daily operations within the department. Tracks, communicates, and compares key terms and conditions and reviews the language of all managed care contracts to ensure terms and conditions meet the standards established by the Managed Care Department. Manages multiple projects within required timelines. Performs data entry, maintenance, and reporting for database of all active contracts as well as other hospital information systems. Supports negotiations by providing reports or other contract comparison tools. Negotiates with health plans on a case by case basis for services not covered under contract.

Quality Assurance Director

Develops, implements, and coordinates, through support staff and lower echelon managers, product assurance program to prevent or eliminate defects in new or existing products. Typically reports to Quality Control Top Officer and Quality Assurance Manager reports to this position. NOTE--For hospitals, please see Quality Assurance Head Hospitals.: Analyzes, evaluates, and presents information concerning factors, such as business situations, production capabilities, manufacturing problems, economic trends, and design and development of new products for consideration by other members of management team. Suggests and debates alternative methods and procedures in solving problems and meeting changing market opportunities. Cooperates with other top management personnel in formulating and establishing company policies, operating procedures, and goals. Develops initial and subsequent modifications of product designs to delineate areas of responsibility, personnel requirements, and operational procedures within program, according to and consistent with company goals and policies. Evaluates contents of reports from product assurance program department heads and confers with top management personnel preparatory to formulating fiscal budget for product assurance program. Conducts management meetings with product design department heads to establish, delineate, and review program organizational policies, to coordinate functions and operations between departments, and to establish responsibilities and procedures for attaining objectives. Reviews technical problems and procedures of departments and recommends solutions to problems or changes in procedures. Visits and confers with representatives of material and component vendors to obtain information related to supply quality, capacity of vendor to meet orders, and vendor quality standards. Confers with engineers about quality assurance of new products designed and manufactured products on market to rectify problems. Reviews technical publications, articles, and abstracts to stay abreast of technical developments in industry.

Head of Quality Improvement- MD

Provides executive leadership over the hospital’s quality improvement process and programs.: Leads the organization's medical quality improvement programs and processes. Provides training and guidance to staff to ensure understanding and that quality, accreditation, and performance improvement are actively pursued. Defines methodologies and directs the collection and analysis of data. Implements processes and methodologies for the identification and sharing of best practices. Promotes support for best practices and evidence-based medicine. Coordinates and oversees quality improvement efforts in operating units. Develops strategic initiatives and transforms initiatives into action plans. Develops and fosters effective collaboration between departments and other affiliated services to ensure an integrated approach to quality management. Facilitates and coordinates the redesign of processes and systems for improvement with a central focus on patient centered care and services, customer satisfaction, safety, resource efficiency, quality, and employee satisfaction. Develops new strategies to improve overall performance. Hires, develops and motivates a qualified quality management/improvement staff. This position requires a Medical Doctor.

Total Quality Management TQI Executive

Provides executive leadership over the hospital’s quality improvement process and programs.: This is not a quality assurance position. Directs the development and implementation of programs and processes related to quality management and performance improvement. Directs and controls quality systems for clinical laboratories. Develops policies and procedures, monitors performance, and develops/reviews metrics for areas of responsibility. Identifies, analyzes, designs, measures, and continuously improves business processes that cut across functional boundaries. Assesses and prioritizes risk, conducts mock inspections, and reports results to senior management. May establish quality improvement project teams. Provides training and guidance to staff to ensure understanding and that quality, accreditation, and performance improvement are actively pursued. Implements processes and methodologies for the identification and sharing of best practices. Develops strategic initiatives and transforms initiatives into action plans. Develops and fosters effective collaboration between departments and other affiliated services to ensure an integrated approach to quality management. Facilitates and coordinates the redesign of processes and systems for improvement with a central focus on patient centered care and services, customer satisfaction, safety, resource efficiency, quality, and employee satisfaction. Develops new strategies to improve overall performance. Hires, develops and motivates a qualified quality management staff. An advanced degree in health care administration is commonly required for this position. The position requires strong clinical and quality management knowledge.

Quality Coordinator Hospital

Interprets and implements quality assurance standards in clinical area or hospital to ensure quality care to patients. Ensures appropriate care is provided to patients. Reviews quality assurance standards, studies existing policies and procedures, and interviews personnel and patients to evaluate effectiveness of quality assurance program. May report to Quality Assurance Head Hospital or a similar high-level position. Position typically requires a bachelor's degree in the field of nursing.: Serves as a professional resource to nursing staff. Writes quality assurance policies and procedures. Reviews and evaluates patients' medical records, applying quality assurance criteria. Selects specific topics for review, such as problem procedures, drugs, high volume cases, high risk cases, or other factors. Compiles statistical data and writes narrative reports summarizing quality assurance findings. May review patient records, applying utilization review criteria, to determine need for admission and continued stay in hospital. May oversee personnel engaged in quality assurance review of medical records.

Quality Assurance Team Leader

Assists quality assurance supervisor in coordinating and monitoring activities of workers engaged in inspecting and testing assembled motor vehicles, components, and parts, as vehicles and subassemblies proceed through stages of assembly process, applying knowledge of quality assurance standards and procedures: confers with supervisor and reviews assembly specifications and production schedules. Assigns workers to work stations and monitors department activities. Interprets standards and procedures, and assists workers in resolving technical problems. Reports unresolved problems to supervisor. Demonstrates tools, equipment, and work aids used in performing quality assurance tasks. May attend management meetings to represent work group and record minutes of meeting. May conduct work group (team) meetings to relay management information to workers, and solicit response to work-related problems. May perform duties of absent workers to maintain work schedules.

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