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Job Description

Oversee the development of the Quality Improvement Plan;

2. Work with practices and community providers in the implementation of the Quality Improvement

Program;

3. Ensure the PCCM-e completes the required QIP and meets required benchmarks;

4. Review and report data to the Medical Director, and conveys information related to Quality Measures,

QIPs, and any Agency directed quality initiatives adopted by the Agency to the PCCM-e;

5. Support the care coordination activities of those in the Region that are at the highest risk and cost

along with other areas of focus as chosen by the PCCM-e; and

6. Ensure quality of services are provided in accordance with state and federal regulations

We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to [email protected] learn more about how we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/.

Skills and Requirements

1. Education requirement is one of the following:

a. Bachelor’s degree in public health, public administration or healthcare quality and safety,

master’s degree preferred.

2. Certified Professional in Healthcare Quality (CPHQ) or equivalent experience related to healthcare

quality

3. Clinical background preferred

4. Prior experience, at least one year, working with the Medicaid population.

5. Familiarity with Healthcare Effectiveness Data and Information Set (HEDIS), CAPHS, and other

standardized quality measures/assessments

6. Proficiency in quantitative data analysis

Statement of Work: Quality Care

Director

v. 09.22.25 Proprietary. Not For Distribution 2

7. At least 3 years’ experience related to population health management, including interpretation and

presentation of data; identifying opportunities for improvement, and developing strategic plans to

address quality deficits.

Population Health Management strategies – Oversees the PCCM-e quality Improvement Plan by:

a. Systematic data analysis to target Medicaid recipients and providers for outreach, education,

and intervention to improve health outcomes.

b. Monitoring system access to care, services, and treatment including linkage to a Medical Home.

c. Monitoring quality and effectiveness of interventions to the population

d. Facilitating quality improvement activities that educate, support, and monitor Providers

regarding evidence-based care for best practice.

e. Implementing clinical management initiatives identified as priorities by the Agency and the

PCCM-e.

8. Must live in one of the following counties: Bibb, Colbert, Fayette, Franklin, Greene, Hale, Lamar,

Lauderdale, Lawrence, Marion, Pickens, Sumter, Tuscaloosa, Walker or Winston.

9. Has not worked for and/or been employed by the Alabama Medicaid Agency within the past two yea