Summary:- Provides strategic leadership for Value-Based Care quality operations, developing and executing quality strategies to optimize performance across Medicare Advantage, commercial payer contracts, Accountable Care Organization (ACO), and clinically integrated network programs.
- Leads Stars and Healthcare Effectiveness Data and Information Set (HEDIS ) performance improvement, maintains National Committee for Quality Assurance (NCQA ) accreditation, advances quality analytics and technology capabilities, and partners with provider networks and quality committees to drive measurable improvement in healthcare quality outcomes.
Minimum Qualifications:Required Education and Experience:
- Bachelor's degree in Nursing, Business OR Health Care Administration
- Preferred Education: Master's degree in Healthcare, Nursing or Business
- 10 years of experience leading Medicare Advantage focused health plan quality improvements to include NCQA, Stars, and HEDIS
*Any equivalent combination of education and experience that provides the required knowledge, skills, and abilities to perform the essential duties and responsibilities of the position.
Other Requirements:- Knowledge of NCQA standards for Population Health and Health Plan accreditation submissions.
- Deep understanding of Medicare Advantage HEDIS standards, strategies, and processes, including Care Gap Closure.
- Understanding of CMS policies impacting CMS Star Ratings through 2030.
- Advanced analytical knowledge to measure and predict performance in HEDIS, HOS, and CAHPS.
Facility: BayCare Health System, Admin - Non Hospital Related-BHS
Location: 300 Park Place Blvd. Clearwater, FL 33759
Status: Full Time, Exempt: Yes
Shift Hours: Varies
Weekend Work: Occasional
On Call: NoHow often will this team member be working remotely? Never
