Director Quality Improvement MFC

1 week ago

Baltimore, Maryland, United States MEDSTAR HEALTH Full time

General Summary of Position
The position is a crucial role in overseeing and directing quality improvement initiatives within MedStar Family Choice. Responsible for developing and implementing strategies to enhance the quality of care, improve health outcomes, and ensure compliance with regulatory standards. The Director collaborates with cross-functional teams, healthcare providers, and external stakeholders to drive continuous quality improvement and promote a culture of excellence in healthcare delivery.
This is a pivotal role in developing and implementing a comprehensive quality improvement strategy that aligns with MedStar Family Choice's mission, vision, and strategic objectives. Leads cross-functional teams, collaborate with healthcare providers and network partners, and engage with regulatory agencies to drive continuous improvement in healthcare quality and performance. Identifies quality improvement priorities, setting measurable objectives, and implementing evidence-based interventions to address identified quality gaps in care. Leverages advanced analytics and data-driven insights to monitor performance, identify trends, and drive actionable recommendations for improvement.

Fosters a culture of quality and accountability by communicating, collaborating, and working closely with internal departments, healthcare providers, and external stakeholders. Provides training, education and support to internal staff and network partners on quality improvement methodologies, performance measurement and regulatory requirements.

Primary Duties and Responsibilities

Leads the development and implementation of a comprehensive quality improvement strategy aligned with MedStar Family Choice goals and objectives.Identifies key areas for improvement, set measurable objectives, and establish performance metrics to monitor progress and outcomes.Directs and oversees quality improvement initiatives across the health plan, including but not limited to HEDIS measures, EPSDT measures, NCQA and EQRO accreditation.Collaborates with cross-functional teams to develop action plans, implement interventions and monitor performance against quality targets.Utilizes advanced data analytics and healthcare informatics to analyze healthcare data, identify trends, and drive performance initiatives.Develops and maintains comprehensive reports, dashboards, scorecards to track quality metrics, performance trends, and improvement opportunities.Prepares, analyzes, and oversees special reports such as CAHPS, EPSDT, Provider Satisfaction, Annual Technical Report, SPR, Performance Improvement Projects (PIPS), Value Based Purchasing (VBP), and Encounter Data Validation.Oversees and supervises annual quality audits performed by the external quality review organization (EQRO) and NCQA, HEDIS, EPSDT, Encounter Validation Data, Network Adequacy Validation, and System Performance Review.Lead efforts to continuously evaluate and improve quality improvement processes, tools, and methodologies based on industry best practices and organizational needs.Fosters a culture of continuous improvement by encouraging innovations, soliciting feedback, and empowering staff to take ownership of quality improvement initiatives.Coordinates and conducts studies for the various quality measures required by State regulatory guidelines and NCQA. Evaluates member satisfaction and provider satisfaction and make modifications as necessary to improve satisfaction.Provides training, education, and support to internal staff, healthcare providers, and network partners on quality improvement methodologies, performance measurement, and regulatory requirements.Facilitates learning opportunities and knowledge-sharing sessions to promote awareness, understanding, and adoption of quality improvement best practices.Assists with organizing the agenda and actively participate in Quality Improvement Committee meetings, other departmental meetings, and State meetings as directed. Oversees the preparation and distribution of agendas and minutes for committee meetings.Develops department goals, objectives, policies, and procedures. Ensures compliance with business unit policies and procedures and governmental and accreditation regulations.Supervises and monitors the effectiveness of contracted vendors who assist with outreach, wellness, member/enrollee service, and quality efforts. Oversees the development of a Corrective Action Plan when goals are not met.Oversees the development, preparation, and delivery of meaningful real-time Provider Scorecards to MFC's participating providers to educate, inform, and assist them in obtaining MFC's goals and objectives. Oversees and assists with MedStar Medical Group's Quarterly POD meetings to deliver Provider Scorecards and perform face-to-face provider education on MFC's QI Program.Works collaboratively with the Information Systems Team and Senior Data Analyst to develop reports to meet the department's annual objectives. Uses technology to enhance decision-making and effectiveness.Oversees the development, implementation, and revision of wellness and preventative care programs, goals, and interventions. Ensures that each area meets targeted goals as determined by the regulatory jurisdiction such as Value Based Purchasing (VPB), EOSDT, and HEDIS. The goal is at minimum neutral to incentive targets and/or NCQA 75th to 90th percentile.Identifies target populations, geographic areas, and key stakeholders to prioritize outreach efforts and maximize impact.

Minimum Qualifications
Education

  • Bachelor's degree in healthcare field (BSN preferred). required and
  • Master's degree in healthcare field preferred

Experience

  • 5-7 years Quality improvement experience within a health plan, preferably a managed Care Organization (MCO), 3 years supervisory experience system development and implementation experience. required and
  • 5-7 years Supervisory experience; system development and implementation experiences required and
  • 5-7 years Diverse clinical experience required

Licenses and Certifications

  • RN - Registered Nurse - State Licensure and/or Compact State Licensure Valid RN license in the local area serving (State of Maryland or District of Columbia); Upon Hire preferred or
  • certification in healthcare related field. Upon Hire preferred and
  • CPHQ - Certified Professional in Healthcare Quality CPHQ certification Upon Hire preferred

Knowledge, Skills, and Abilities

  • Knowledge of current trends in health care delivery and population management.
  • Knowledge of NCQA, HEDIS, EQRO audits and local regulatory guidelines preferred.
  • Strong analytical skills, technical writing skills, excellent problem-solving skills and ability to exercise independent judgment.
  • Business acumen and leadership skills.
  • Strong verbal and written communication skills with ability to effectively interact with all levels of management, internal departments and external agencies.
  • Proficient with Microsoft Office applications especially Word, Excel and PowerPoint.
  • Ability to enter and retrieve information using a PC.
  • Working knowledge of various computer software applications.

Why MedStar Health?
At MedStar Health, we understand that our ability to treat others well begins with how we treat each other. We work hard to foster an inclusive and positive environment where our associates feel valued, connected, and empowered. We live up to this promise through:

  • Strong emphasis on teamwork - our associates feel connected to each other and our mission as an organization. In return, our effective team environment generates positive patient outcomes and high associate satisfaction ratings that exceed the national benchmark.
  • Strategic focus on equity, inclusion, & diversity - we are committed to equity for all people and communities. We continue to build a diverse and inclusive workplace where people feel a sense of belonging and the ability to contribute to equitable care delivery and improved community health outcomes at all levels of the organization.
  • Comprehensive total rewards package - including competitive pay, generous paid time off, great health and wellness benefits, retirement savings, education assistance, and so much more.
  • More career opportunities closer to home - as the largest healthcare provider in the Baltimore-Washington, D.C. region, there are countless opportunities to grow your career and fulfill your aspirations.

About MedStar Health
MedStar Health is dedicated to providing the highest quality care for people in Maryland and the Washington, D.C., region, while advancing the practice of medicine through education, innovation, and research. Our team of 32,000 includes physicians, nurses, residents, fellows, and many other clinical and non-clinical associates working in a variety of settings across our health system, including 10 hospitals and more than 300 community-based locations, the largest home health provider in the region, and highly respected institutes dedicated to research and innovation. As the medical education and clinical partner of Georgetown University for more than 20 years, MedStar Health is dedicated not only to teaching the next generation of doctors, but also to the continuing education, professional development, and personal fulfillment of our whole team. Together, we use the best of our minds and the best of our hearts to serve our patients, those who care for them, and our communities. It's how we treat people.

MedStar Health is an Equal Opportunity (EO) Employer and assures equal opportunity for all applicants and employees. We hire people to work in different locations, and we comply with the federal, state and local laws governing each of those locations. MedStar Health makes all decisions regarding employment, including for example, hiring, transfer, promotion, compensation, benefit eligibility, discipline, and discharge without regard to any protected status, including race, color, creed, religion, national origin, citizenship status, sex, age, disability, veteran status, marital status, sexual orientation, gender identity or expression, political affiliations, or any other characteristic protected by federal, state or local EO laws. If you receive an offer of employment, it is MedStar Health's policy to hire its employees on an at-will basis, which means you or MedStar Health may terminate this relationship at any time, for any reason.

  • Senior Quality Improvement Specialist

    1 month ago

    Baltimore, Maryland, United States Johns Hopkins Medicine Full time

    The Johns Hopkins Hospital is a world-renowned leader in patient care, serving the greater Baltimore community and patients from all across the globe. Our friendly and knowledgeable staff teams provide support throughout our many specialty departments and centers, from primary visits to emergency care. What Awaits You?Career growth and developmentTuition...

  • Stroke Quality Improvement Nurse

    3 weeks ago

    Baltimore, Maryland, United States Johns Hopkins Medicine Full time

    One organization. Countless opportunities. Eligible for $10k sign-on bonus The Johns Hopkins Hospital achieved the 2023 American Heart Association/American Stroke Association's Stroke Gold Plus Quality Achievement Award. Join us and make a differenceHybrid opportunity for a registered nurse with stroke experience who wants to work with data and quality...

  • Stroke Quality Improvement Nurse

    1 month ago

    Baltimore, Maryland, United States Johns Hopkins Medicine Full time

    One organization. Countless opportunities. Eligible for $10k sign-on bonus The Johns Hopkins Hospital achieved the 2023 American Heart Association/American Stroke Association's Stroke Gold Plus Quality Achievement Award. Join us and make a differenceHybrid opportunity for a registered nurse with stroke experience who wants to work with data and quality...

  • Medical Appeals/Grievances Analyst

    1 month ago

    Baltimore, Maryland, United States MEDSTAR HEALTH Full time

    Manages Maryland and District of Columbia member and provider medical appeals, Maryland complaints and grievances. Responsible for member advocate functions. Interacts directly with members, staff, physicians, and others on the telephone to resolve issues. Acts as a resource and documents all information as it relates to medical appeals/complaints and...

  • Medical Appeals/Grievances Analyst

    3 weeks ago

    Baltimore, Maryland, United States MEDSTAR HEALTH Full time

    Manages Maryland and District of Columbia member and provider medical appeals, Maryland complaints and grievances. Responsible for member advocate functions. Interacts directly with members, staff, physicians, and others on the telephone to resolve issues. Acts as a resource and documents all information as it relates to medical appeals/complaints and...

  • Supplier Quality Field Rep Stf

    7 days ago

    Baltimore, Maryland, United States Lockheed Martin Full time

    Job ID: 665731BRDate posted: May. 08, 2024Description:Lockheed Martin is seeking a Supplier Quality Field Representative (SQFR) for a position based in the Central Maryland Area region of the United States. The position will require working flexible hours and frequent travel to support suppliers across the United States. The SQFR will operate from a home...

  • Research Quality Improvement

    7 days ago

    Baltimore, Maryland, United States InsideHigherEd Full time

    Job DescriptionReg or CII Exempt StaffQualificationsReg or CII Exempt StaffJob: Reg or CII Exempt StaffShift: Day JobOrganization: School of Medicine - Marlene and Stewart Greenebaum Comprehensive Cancer CenterJob Posting: Mar 29, 2024Unposting Date: Ongoing

  • Research Quality Improvement and Compliance Specialist

    7 days ago

    Baltimore, Maryland, United States University of Maryland, Batlimore Full time

    The University of Maryland, Baltimore Marlene & Stewart Greenebaum Comprehensive Cancer Center (UMGCCC) is seeking a full-time, exempt Research Quality Improvement and Compliance Specialist within the Clinical Research Management Office. The Specialist is responsible for the management of all regulatory and compliance matters related to a caseload of...

  • Research Quality Improvement and Compliance Specialist

    7 days ago

    Baltimore, Maryland, United States University of Maryland, Batlimore Full time

    The University of Maryland, Baltimore Marlene & Stewart Greenebaum Comprehensive Cancer Center (UMGCCC) is seeking a full-time, exempt Research Quality Improvement and Compliance Specialist within the Clinical Research Management Office. The Specialist is responsible for the management of all regulatory and compliance matters related to a caseload of...

  • Medical Appeals/Grievances Analyst

    1 month ago

    Baltimore, Maryland, United States MEDSTAR HEALTH Full time

    General Summary of PositionMonday - Friday, 8:30am - 5pm schedule. Position requires 1 day per week on-site (office located in Rosedale, Maryland)Manages Maryland and District of Columbia member and provider medical appeals, Maryland complaints and grievances. Responsible for member advocate functions. Interacts directly with members, staff, physicians, and...

  • Medical Appeals/Grievances Analyst

    3 weeks ago

    Baltimore, Maryland, United States MEDSTAR HEALTH Full time

    General Summary of PositionMonday - Friday, 8:30am - 5pm schedule. Position requires 1 day per week on-site (office located in Rosedale, Maryland)Manages Maryland and District of Columbia member and provider medical appeals, Maryland complaints and grievances. Responsible for member advocate functions. Interacts directly with members, staff, physicians, and...

  • Continuous Improvement and Logistics Engineer

    1 week ago

    Baltimore, Maryland, United States Johnson Controls International Full time

    Be part of the futureWe are one team, dedicated to working collaboratively to create the purposeful solutions that propel the world forward. We hope you will join our diverse team of top people – you bring your talent, and we'll give you the space and opportunities to grow and succeed. We are committed to make a difference.What we offer:Competitive...

  • Quality and Compliance Coordinator

    1 week ago

    Baltimore, Maryland, United States The University of Maryland Medical System Full time

    Treating over 330,000 patients every year, the University of Maryland Medical Center is at the vital core of Maryland's health care system and community. We're known for our prestigious expertise in innovative research and education, along with the talented staff and advanced centers that make it all possible. The R Adams Cowley Shock Trauma Center, the...

  • nurse specialist ambulatory quality

    1 week ago

    Baltimore, Maryland, United States LifeBridge Health Full time

    NURSE SPECIALIST AMBULATORY QUALITY Baltimore, MD SINAI Full-time - Day shift - 8:00am-4:30pm RN Other 83323 Posted: May 14, 2024 Apply NowSave Job SavedSummary JOB SUMMARY: Under direction of the Director of Ambulatory and Physician Practice Outcomes, the Ambulatory Quality Outcomes Coordinator collects, analyzes, interprets and facilitates...

  • division director

    2 months ago

    Baltimore, Maryland, United States LifeBridge Health Full time

    The Herman and Walter Samuelson Children's Hospital at Sinai Hospital of Baltimore is seeking a Division Director of Pediatric Endocrinology to join its Division of Pediatric Endocrinology.The Pediatric Endocrinology practice is located on the modern campus of Sinai Hospital at Baltimore. The campus is ideally located in easy driving distance to the...

  • Program Director

    1 week ago

    Baltimore, Maryland, United States Exodus Management Group, LLC. Full time

    As a key member of the senior management team, the PRP Director is responsible for the overall management of the PRP Program, which includes but is not limited to maintaining program operations, staff, recruitment of clients, obtaining authorizations, collaborating with treatment teams, and establishing and following a set of policies and processes. The PRP...

  • Operations Director

    7 days ago

    Baltimore, Maryland, United States LifeBridge Health Full time

    Summary POSITION SUMMARY: The Director-Practice Operations will oversee inpatient services for Hospital Medicine, Critical Care Medicine at Sinai Hospital and Northwest Hospital. Directs the operations for the designated faculty physician offices both on campus at Sinai and Northwest, and off-campus practices. Assists with administrative support for...

  • Sr. Performance Improvement Spec

    3 weeks ago

    Baltimore, Maryland, United States Johns Hopkins Medicine Full time

    YOU BELONG HEREWhat Awaits You?Career growth and developmentEmployee and Dependent Tuition Assistance Diverse and collaborative working environmentAffordable and comprehensive benefits packageOur competitive Benefit Package is designed to support the well-being and financial security of our employees. You can explore the details of our benefits offering by...

  • Sr. Performance Improvement Spec

    1 month ago

    Baltimore, Maryland, United States Johns Hopkins Medicine Full time

    YOU BELONG HEREWhat Awaits You?Career growth and developmentEmployee and Dependent Tuition Assistance Diverse and collaborative working environmentAffordable and comprehensive benefits packageOur competitive Benefit Package is designed to support the well-being and financial security of our employees. You can explore the details of our benefits offering by...

  • Program Director

    1 week ago

    Baltimore, Maryland, United States Exodus Management Group, LLC. Full time

    As a crucial member of the senior management team, the PRP Director holds the responsibility for the overall management of the PRP Program. This includes maintaining program operations, staff coordination, client recruitment, authorization acquisition, collaboration with treatment teams, and the establishment of policies and processes.The PRP Director...