Director Quality

Calling all Esteemed Leaders
Are you a visionary strategist with a deep passion for healthcare quality and improvement? Have you worked in a Health Plan specific environment?  Do you excel in leading transformative initiatives and ensuring excellence in health plan ratings? If so, we have a prime opportunity for you

The Role:
As the Director of Quality, you will be at the forefront of our efforts to enhance clinical and member experience outcomes and maintain high scores within key health plan ratings, such as CMS MA Star Ratings, NCQA ratings & accreditation, Exchange QRS ratings, and Medicaid quality. Based in our innovative environment, you'll lead the charge in designing quality programs, closing quality care gap measures, and integrating care gap closure into value-based contracting.

What You'll Do:

• Quality Strategy & Program Design: Define and craft overarching strategies to achieve exceptional performance in key quality programs, optimizing clinical quality and member experience measures.
• Quality Improvement: Implement precise quality improvement programs with defined ROI and feedback loops, tracking effectiveness meticulously and driving operational processes to achieve strategic imperatives.
• HEDIS and Supplemental Data: Spearhead strategy development to meet performance goals in HEDIS and supplemental data, ensuring strong performance in pivotal quality measures like MA Stars and HEDIS.
• Resource Management: Prioritize resources and make capital budgeting decisions to manage multiple priorities efficiently.
• Data-Driven Analysis: Analyze data from the clinical quality analytics team to develop interventions and oversee quality performance reporting.
• Health Equity: Partner with Health Equity leadership to implement strategies addressing health equity.
• Quality Issue Resolution: Investigate potential quality of care issues, assess systemic and case-specific problems, and facilitate barrier analysis and process improvement.
• Vendor Management: Oversee vendor contracts for HEDIS auditing, NCQA HEDIS reporting, and regulatory/accreditation-related surveys.
• Team Leadership: Establish departmental priorities, manage core leaders and caregiver staff, promote professional development, and ensure comprehensive policy implementation.

What You'll Bring:

• Educational Background: Bachelor's Degree in a business or healthcare-related field; Master's Degree in Public Health, Healthcare Administration, Business Administration or relevant programs is preferred.
• Experience: 7 years of management or supervisory experience in a health plan and 5 years in quality improvement program planning, with a focus on MA star program management.
• Specialized Knowledge: 3 years of experience in HEDIS audits and expertise in quality management principles and tools like Six Sigma, Root Cause Analysis, PDSA, and Lean methodologies.
• Certifications: Certified Professional in Healthcare Quality (CPHQ) preferred.
• Leadership Abilities: Proficient in leading the development of quality strategies and managing matrixed collaborations.
• Regulatory Expertise: Deep understanding of regulatory requirements and program design to achieve superior health plan ratings.
• Skills: Strong project management, team management, organizational, interpersonal, and communication skills.
• Problem-Solving Prowess: Detail-oriented, systems thinker with adaptive and goal-oriented problem-solving abilities.

Why Join Us?

• Transformative Impact: Be a pivotal part of an organization committed to transforming healthcare quality and impacting communities positively.
• Empowered Innovation: Experience autonomy and support to bring your innovative ideas to fruition.
• Collaborative Excellence: Work alongside a talented team dedicated to their craft and passionate about healthcare.
• Dynamic Growth: Thrive in a fast-paced industry with constant opportunities for professional growth and adaptation.

Ready to Drive Healthcare Excellence?
If you're a strategic leader with a zeal for healthcare improvement, we invite you to apply Join our team and contribute to a healthier, brighter future for all.