The Director Quality Operations provides strategic leadership and direction for the quality improvement program to the local market. The Director of Quality Operations works within highly matrixed relationships to develop and operationalize the overall quality strategy for the market ensuring the quality program is proactive, continuously improving to include quality management / improvement and regulatory adherence. This position provides insight and direction to the market to align with a changing healthcare landscape as it applies to quality.
He / she is responsible for driving and executing strategy to ensure optimal HEDIS / CMS Star results. Responsibilities including but not limited to HEDIS, CAHPS, HOS Standards, and Quality initiatives related to appropriate coding,, driving deployment and relentless day to day operational monitoring of region / market as applicable. The improvements will drive increased HEDIS / Star Ratings. This includes partnering closely with the VP of Quality, QRA Medical Director, and local market Cross functional leadership.
The Director of Quality Operations is the population health expert for the market and assesses gaps in programs and disparities, proactively communicating the needs and driving innovation to find programs to work at the local or market level. The Director understands and influences Member and Provider Engagement Programs deployed in the market and assures day to day oversight to close member gaps in care.
Primary Responsibilities:- Drives programs and initiatives to assure member access to care and gaps in care closure
- Partners with VP of Quality, QRA Medical Director, and local market Cross functional leadership to ensure established quality goals are met
- Manages assigned market / state Quality Improvement goals to drive and track data capture and collection, provider engagement and value based contracting, member engagement programs, clinical, and customer care touch points
- Aligns and coordinates deliverables within their market / region and among the team including but not limited to: CMS Star program, HEDIS data collection, Data Analytics and Reporting, CAHPS Member Surveys, HOS member surveys, ICD10/CPT/CPT II coding capture related to Quality initiatives, and Regulatory Adherence, and Member/Provider Engagement
- Display innovative problem solving and upholds principles of continuous quality improvement
- Meet annual goals and objectives for the market and key metrics in conjunction & under the direction of the VP of Quality, cross functional teams and corporate goals and strategies to meet and exceed established program objectives
- Monitors daily, weekly, monthly, quarterly, semi-annual and annual reports against goals to assess program success and alignment and to identify opportunities for improvement
- Accountable for and assists with Quality Strategy Business Plan
- Accountability for and knowledge of the Quality Improvement, CMS/Star Rating information and updates, NCQA/HEDIS, and gap metrics for assigned market
- Appropriate application to form information to strategy to drive the market to excellence
- Performs all other related duties as assigned
You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Required Qualifications:- 5+ years of significant and progressive leadership or managerial experience and responsibilities. Management of process or discreet work stream is acceptable
- 5+ years of experience in, and/or knowledge of, Clinical Quality and Quality Improvement processes required NCQA/HEDIS, CMS Star Program , ICD10/CPT/CPT II coding and CAHPS/HOS
- 3+ years of management experience
- Excellent interpersonal skills
- Superior verbal and written communication skills; ability to speak clearly and concisely, conveying complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information from others
- Proven problem-solving skills; the ability to systematically analyze problems, draw relevant conclusions and devise appropriate courses of action
- Performance driven
- Exceptional analytical and data representation expertise
- Advanced knowledge of Microsoft Office applications, including, but not limited to, Word, Excel, Visio and PowerPoint
- Driver's license and access to reliable transportation
Preferred Qualifications:- Clinical Registered Nurse or other related clinical experience or education
- Certified Professional Healthcare Quality (CPHQ)
- 5+ years of experience working in managed care or a healthcare delivery system
- Project Management experience
- Solid knowledge base of clinical standards of care, preventative health and STAR measures
- Solid financial analytical background within Medicare Advantage plans (Risk Adjustment/STARS Calculation models)
Physical & Mental Requirements:- Ability to lift up to 10 pounds
- Ability to sit for extended periods of time
- Ability to stand for extended periods of time
- Ability to use fine motor skills to operate office equipment and/or machinery
- Ability to receive and comprehend instructions verbally and/or in writing
- Ability to use logical reasoning for simple and complex problem solving
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $91,700 - $163,700 annually based on full-time employment. We comply with all minimum wage laws as applicable.
