$200K — $250K *
Provide executive leadership and develop enterprise-wide, results oriented quality strategy to drive improvements at the national, regional and market level. Responsible for the overall coordination, implementation, and monitoring of activities to yield quality driven, innovative, compliant, efficient, and cost-effective results.
Acts as an Advocate for, and support, the business by serving as a quality champion through measuring and monitoring the quality and effectiveness of work processes that impact customer satisfaction, medical cost management, and operational efficiency. Consult and/or work cross functionally to influence and promote change to continually deliver quality service to our internal and external customers.
• Sets the direction of the strategic business plan and translates into vision for staff/others.
• Ensures the implementation and ongoing execution of the Health Care Quality Management Program to support business, regulatory and accreditation requirements, and improve HEDIS Stars results
• Foster a culture of quality using innovation, integration and information to support revenue and membership growth while achieving business goals.
• Establish strategic relationships with executive leadership throughout the organization to develop and remove barriers, if needed, to implement program strategies that meet business, regulatory and accreditation requirements.
• As a business leader, influences all stake holders, internal and external, to support key projects/programs to ensure positive outcomes that deliver on results.
• Build strong high performing leadership teams through training, stretch assignments, coaching, performance management and other development techniques.
• Maintains a working knowledge of legislative changes that may potentially affect quality and care management practices and standards.
• Complete regular data analysis to identify trends that that identify gaps in care for the Medicaid populations.
• Collaborate with the Clinical and Program Innovations team to address population level interventions that address overall gaps in care supporting the Population Management franchise models.
• 8-10 years clinical/managed care/health care industry experience
• Previous quality improvement and management experience in a managed care organization required
• Thorough knowledge of NCQA and/or HEDIS management
• Multiple years proven leadership experience setting strategic direction and influencing change that resulted in quantifiable positive outcomes
• Proven history managing complex projects and or programs that resulted in cost savings
• Experience managing large budgets
• Demonstrated negotiation skills
• Effective and advanced organizational, decision-making, and analytical skills required
• Excellent verbal and written communication skills.
• Proficient computer skills and knowledge of Microsoft Word, Excel and Access
• Ability to work in a demanding environment
• Demonstrated ability to anticipate customer needs and requirements
• Ability to communicate effectively with all levels of management
Additional Job Information
Master's prepared preferred
Bachelor's degree or equivalent experience
Percent of Travel Required
10 - 25%
Valid through: 12/25/2020