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Senior Director of Quality Data

2 months ago

Camarillo, California, United States Gold Coast Health Plan Full time
Job Summary

Gold Coast Health Plan is seeking a highly skilled Senior Director, Quality Data to lead our Quality Data program and regulatory operations. This role will provide direction and supervision to the Quality Data team and oversee all aspects of the program, including vendor oversight, technical solutioning, data optimization, and management of strategic efforts to maximize quality results.

Key Responsibilities
  • Provide direction and supervision to the Quality Data team
  • Lead all aspects of the Quality Data program and regulatory operations
  • Oversee vendor oversight, technical solutioning, data optimization, and management of strategic efforts to maximize quality results
  • Establish and support data solutions to ensure adequate claims and encounter data collection
  • Develop and maintain strong relationships with providers to facilitate data integration and collaboration
  • Deliver quality and value in a fast-paced, dynamic environment to support our Medicare and Medi-Cal programs
  • Collaborate with partners across the organization to support the HEDIS program and related activities
  • Build and maintain strong relationships with IT, Operations, Network Management, Compliance, and provider partners
  • Ensure accuracy and compliance with all CMS and DHCS guidelines regarding quality measure sets
  • Coordinate care with appropriate functional areas for quality measure sets compliance
Requirements
  • Master's degree in a healthcare-related profession
  • Experience leading quality data programs in a complex provider or health plan environment
  • Minimum of eight or more years of relevant experience in a complex healthcare setting
  • Progressive management experience with in-depth expertise in quality and process improvement methodologies, statistical analysis, and data base management
  • Expert working knowledge of current quality measures and data best practices in the healthcare industry
  • Broad technology experience across several key areas, including cloud architecture, analytics, machine learning, DevOps, CI/CD, data quality management, and digital transformation
  • Experience in the design and implementation of complex IT solutions, including scalable cloud-based solutions
  • Experience with large enterprise-level systems and managing data at scale
  • Experience with multiple public cloud providers (Azure preferred)
  • Strong technical foundation with a solid background in architectural patterns involving Digital Experience Strategy and ability to map technology concepts across various technology platforms
  • Strong computer, data analysis, communication, and project management skills
  • Comprehensive and thorough understanding of all elements of healthcare delivery, including strategy development, business planning, operations, and financial issues
  • Experience and ability to work effectively with all levels of organization, including department leadership, provider leadership, and other members of the medical staff
  • Possess a deep understanding of and expertise in the use of quantitative and qualitative measurements as they apply to analysis of practices, operational procedures, and revenue impact in relationship to quality outcomes
Preferred Qualifications
  • PhD in Biostatistics or a similar field
  • Strong preference for experience leading a similarly structured team
  • Strong preference for experience within a large, complex health system
  • Ten or more years of relevant experience in a complex healthcare setting
  • Certifications in Cloud Technologies preferred (Azure Data Engineer, Solution Architect, etc.)
  • Five or more years of manager (or higher) level experience in a complex healthcare setting
  • Lean Six Sigma Black Belt Certification (LSSBB)
  • Certified Professional in Healthcare Quality (CPHQ) or other related certification