Apply online at http://www.alohacare.org/Careers/Default.aspxThe Opportunity:Reporting to and operating under the strategic oversight of the Senior Vice President, Pharmacy and Quality, the Director, Quality leads AlohaCare's Quality program and is responsible for implementing quality improvement programs across all lines of business, including the annual program description, work plan, and program evaluation. The Director recommends quality priorities, performance targets, resource needs, and corrective actions to the Senior Vice President and provides timely updates on performance, significant risks, regulatory concerns, and barriers requiring executive direction or escalation. The Director works with leaders across Performance Optimization & Population Health, Health Services, Pharmacy, Behavioral Health, Provider Relations, Customer Service, Compliance, Risk Adjustment, and Product Management to attain MedQUEST and CMS quality goals. This position champions strategic quality improvement initiatives and demonstrates leadership through analytical competence, change management, innovative thinking, effective listening and teaching, clear communication, and a commitment to results.
Primary Duties and Responsibilities: - Under the strategic direction of the Senior Vice President, Pharmacy and Quality, leads implementation of AlohaCare's Quality Strategy to improve the health of members and the communities served, strengthen the organization's quality culture, advance priority initiatives, and maintain key internal and external relationships.
- Develops and implements AlohaCare's QAPI, Quality & Performance Improvement and Health Equity Program Description, QI and Health Equity Work Plan, and QI and Health Equity Program Evaluation in collaboration with the Director of Health Equity.
- Recommends annual quality performance targets to the Senior Vice President, Pharmacy and Quality, and leads approved initiatives to improve HEDIS, CAHPS, HOS, Star Ratings, and MedQUEST outcomes. Monitors performance against benchmarks; evaluates intervention effectiveness; identifies barriers and root causes; and ensures timely implementation and follow-through of corrective action plans. Escalates material performance concerns, regulatory risks, resource constraints, and decisions requiring executive direction to the Senior Vice President.
- Develops and provides Quality trainings and educational materials.
- Ensures Quality operations comply with applicable Medicare Special Needs Plan, MedQUEST, HIPAA, and Quality-owned NCQA requirements. Coordinates with Compliance for accreditation standards interpretation, evidence submission, survey readiness, and corrective-action tracking.
- Supports designated Quality Improvement governance committees and, in coordination with the Senior Vice President, Pharmacy and Quality, presents performance results, significant risks, corrective actions, and strategic recommendations to executive leadership and governing bodies. Provides Quality-owned information and documentation requested by Compliance for accreditation reporting and readiness.
- Knowledgeable with all AlohaCare lines of business, products, and cohorts of members from a healthcare quality perspective, as well as the special challenges in rural Hawaii and neighbor islands.
- Develops a high-performing team that collaborates and coordinates effectively within the department and across the organization. Develops direct reports and subordinate leaders in leadership and management capability, building on their individual strengths and commitment to AlohaCare's mission.
- Provides leadership and oversight to the Quality Program Manager, who is responsible for day-to-day management of assigned Quality programs, including EPSDT, patient safety, and quality-of-care activities. Establishes performance expectations, reviews program results and corrective actions, supports resource and barrier resolution, and ensures significant risks and issues are escalated to the Senior Vice President, Pharmacy and Quality.
- Develops and maintains relationships with MedQUEST, CMS, Medicare program stakeholders, the Association for Community Affiliated Plans (ACAP), and other key local and national partners.
- Demonstrates leadership attributes such as active listening, defining issues, resolving conflict, being facilitative, inspiring staff, empowering staff, and training the trainers.
- Develops and recommends the Quality department's resource plan to the Senior Vice President, Pharmacy and Quality. Within approved authority, oversees quality-related vendors, consultants, and delegated activities, including contract deliverables, service-level expectations, regulatory compliance, financial stewardship, and performance.
- Performs other duties assigned.
- Adhere to regulatory compliance and quality guidelines as well as AlohaCare policies and procedures.
- Responsible for maintaining AlohaCare's confidential information in accordance with AlohaCare policies, state and federal laws, rules and regulations regarding confidentiality. Employees have access to AlohaCare data based on the data classification assigned to this job title.
Requirements: - Bachelor's degree in nursing, public health, healthcare administration, business administration, health sciences, or a related field required. An equivalent combination of education and comparable healthcare quality experience may be considered.
- Minimum of 5 years of work experience in Quality Improvement/Quality Assurance for a managed care organization and/or healthcare organization.
- Minimum of 5 years of experience in Medicaid and/or Medicare programs.
- Minimum of 5 years of Quality program development and implementation experience.
- Minimum of 5 years of experience managing and developing a team.
- Knowledge of health plan Quality operations and programs, including PDSA quality improvement methodology.
- Experience with electronic clinical data systems (ECDS), Fast Healthcare Interoperability Resources (FHIR), electronic health record and health information exchange (EHR/HIE) data, interoperability, digital measure conversion, and/or quality technology strategy.
- Experience using healthcare quality, population health, performance dashboard, or quality management technology to monitor outcomes and support improvement initiatives.
- Demonstrated ability to develop and implement performance improvement initiatives to improve Quality metrics.
- Demonstrated ability to interpret quality data, validate performance reporting, assess data completeness and accuracy, and translate findings into actionable strategies. Detailed knowledge of managed care outcome measures required.
- Demonstrated ability to maintain a member- and quality-focused approach.
- Achieves results, builds trust, communicate effectively, customer and quality focused.
- Excellent interpersonal skills with the ability to communicate with all levels of the organization.
- Strong interpersonal, facilitation and leadership skills with ability to interact with various departments/ project teams.
- Excellent, effective, and precise written and oral communication skills; speaks clearly and persuasively in positive or negative situations.
- Ability to work with mathematical concepts such as probability and statistical inference, and ability to apply concepts such as fractions, percentages, ratios, and proportions to practical situations
- Ability to organize, coordinate and supervise large projects in a timely, creative and effective manner.
- Ability to solve problems, analyze, think critically, make good judgments and make fair decisions.
- Experience in project management, management reporting and analysis and excellent in building, maintaining and working with spreadsheets.
- Able to effectively and methodically implement, manage, monitor, track and/or report on assigned tasks and projects
- Able to effectively work in a fast-paced and changing environment, manage multiple projects and priorities across multiple teams/projects and in a matrixed environment.
- Possesses excellent time management and organizational skills; dependable, enthusiastic, self-starting, and self-motivated. Uses time effectively, reacts professionally under pressure.
- Excellent leadership, communication, and analytical skills.
- Strong customer service skills and able to work in a diverse, demanding and evolving environment with strong conflict and problem resolution skills.
- Intermediate skills in Microsoft Programs: Word, Excel, Outlook, and PowerPoint.
- Experience in the operation of general office equipment to include PC, fax/copy machine and phone system.
Preferred Requirements:- Licensed RN in the state of Hawaii.
- Certified Professional in Healthcare Quality (CPHQ) or similar certification in quality strongly preferred
Mental, Physical and Environmental Demands: - Sedentary Work: Exerting up to 20 pounds of force occasionally and/or a negligible amount of force frequently or constantly lift, carry, push, pull, or otherwise move objects. Sedentary work involves sitting most of the time but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally, and all other sedentary criteria are met.
- In office working environment.
- May require prolonged sitting- up to 4 hours.
- Requires prolonged operation of a computer workstation, including the ability to type for extended periods of time on a keyboard during the scheduled workday.?
Salary Range: $111,000 - $145,000 annually
