AVP, Quality Improvement & Performance at Meridian Health Plan in Philadelphia, PA

The Associate Vice President (AVP) of Quality Improvement & Performance will lead the development, execution, and oversight of HPP’s quality improvement strategy, which includes key projects and initiatives focused on improving HPP’s quality performance across all lines of business, improving performance under managed care organization rating systems (e.g., HEDIS, Medicare Stars and Medicaid MCO P4P), management of related value-based payment models and oversight of relationship with strategic provider and vendor partners. This role will be a leader within HPP’s quality improvement governance structure, with a demonstrated ability to effectively lead teams in a matrix organization and use data-driven decision making and techniques to drive performance improvement.

PRIMARY RESPONSIBILITIES

· Lead quality improvement operations and strategies to maximize our performance and ensure regulatory compliance.

· Oversee the development of value-based payment strategies, programs, and methodologies for all lines of business.

· Lead various quality improvement governance committees tasked with improving quality performance, value-based payment programs and oversight of strategic partner relationships.

· Provide strategic and operational support to HPP’s provider engagement initiatives, including performance analysis, performance improvement plans, and integration of SDOH programming.

· Manage the relationships and performance of all quality improvement vendors; Routinely assess the return on investment of all quality improvement vendors.

· Lead the development and support of the DHS (Medicaid) sponsored patient-center medical home (PCMH) initiative.

· Directly contribute to meeting the financial, operational, and performance goals of Health Partners Plans.

· Ensure compliance with Pennsylvania’s Department of Human Services related to various quality programs and mandates.

· Plan and project goals and milestones for the department in line with corporate goals.

· Participate in monthly Joint Operating Committees with large provider organizations and strategic partners.

· Provide regular updates to HPP’s leadership regarding HPP’s performance, departmental operations, prioritization and status of activities in line with corporate goals.

· Direct supervisory responsibilities to maintain a positive work environment that supports self-direction; provide a structure to optimize experience, skill, knowledge, and capability of the team.

EDUCATION, EXPERIENCE, AND SKILLS

Education/Experience: Bachelor’s degree in Health or Business Administration required: Ten or more years’ experience as a strong performer in managed care operations, quality improvement, provider relations, practice management, insurance, or related field required. Prior managerial experience required.

Technical: Must have quantitative analysis skills; Proficient in Microsoft Outlook, Word and Excel, and relational databases.

Communication: Exceptional presentation, oral and written communication, interpersonal, problem solving, multitasking, and time management skills required Communicates clearly & professionally. Maintains composure in challenging situations. Collaborates with others. Asks for constructive feedback. Promotes a culture of diversity, respect & accountability. Challenges other through productive discussion.

Problem Solving & Quality: Pays attention to detail. Identifies & solves complex issues. Thinks “big picture” when assessing problems/opportunities. Develops innovative & creative solutions.

Managing for Results: Follows all company policies & SOPs. Delegates prioritizes and manages the work of others. Balances competing priorities, scheduling issues & deadlines. Delivers effective feedback. Manages cost, quality & expedience.

Leadership & Initiative: Motivates & empowers others. Acts in accordance with company vision, mission & values. Takes accountability for own performance. Willing to take on additional assignments. Seeks out opportunities for leadership & development. Trains, coaches & mentors others. Champions change. Provide leadership, coaches, and /or mentoring to subordinate groups.