Who you will be working with:
The Associate Director, Quality position supports the Quality function for Evolent's clients as he/she (1) designs, builds and manages health plan quality programs that meet State and NCQA requirements; (2) sets strategy, monitors, and optimizes QI initiatives for performance-based payment programs; (3) coordinates care gap closure efforts with other physician-facing initiatives; (4) interacts with Accreditation function to monitor timely NCQA and CMS responses and ensure corresponding Evolent quality improvement actions are taken. For the assigned set of clients, the Associate Director, Quality will drive customization, launch and ongoing operations for Quality Improvement activities with close tie-ins to accreditation-related activities and NCQA state responses.
What You'll Be Doing:
- Identify and prioritize key quality measures critical to client success under its performance based payment programs.
- Work closely with the market team's Medical Director, Senior Director of Clinical Operations, and leadership from Central Quality team.
- Introduce processes to track measure performance toward goals, and based on findings, engage Evolent and client clinical leadership in discussion of potential improvement interventions
- Collaborate with Evolent Quality and Clinical leadership, Program Innovations team, Clinical Informatics, and Reporting to operationalize care gap closure efforts for the client
- 25% travel throughout Florida.
- During the first 90 days, need to be onsite 3 days per week at one of our Florida plans.
Health Plan Quality Programs
- Manages the health plan quality improvement program description (QIPD) the annual evaluation and workplan.
- Prepare and present reports for internal and external client committees (e.g., QIC, Credentialing); prepare and maintain minutes; maintain, review and participate in the revision of departmental and corporate policies, procedures and protocols.
- Manage the implementation and successful completion of Medicaid quality improvement program projects including, but not limited to HEDIS, Chronic Care Improvement Program (CCIP) and Quality Improvement Projects (QIP), and other performance improvement initiatives and State-mandated projects.
- Oversee the tracking, trending and reporting of internal and external quality management data for client health plan
- Assure initial and on-going compliance with state and federal quality improvement requirements
- Assist in the implementation of review/audit plans, self-assessments and other activities to monitor and track ongoing compliance with NCQA standards, federal and state laws, and Medicare/Medicaid rules and regulations.
- Coordinate aspects of the audit program, including maintaining audit files, developing an audit timeline, analysis of audit data, and accurate reporting of all audit results.
- As needed, facilitate NCQA readiness review activities to ensure all accreditation requirements are met.
- Coordinate activities between Risk Adjustment and Proactive Care to ensure seamless, efficient experience for participating physicians
The Experience You Need (Required):
- Clinical training and Masters in health-related field desirable
- Past health plan or managed care environment highly preferred
- 3+ years clinical and/or health care management experience, with general understanding of performance measures (e.g., NCQA/HEDIS measures, MSSP measures, etc.)
- Knowledge of QI/CQI principles, CMS requirements and regulations, and NCQA standards and regulations
- Experience with analyzing HEDIS, CAHPS, HOS and Medicare Star rating data.
Finishing Touches (Preferred):
- Excellent analytical, verbal, written, organizational and interpersonal skills.
- Intermediate level proficiency with Microsoft Office applications and data management reporting.