Sr. Director, Quality Improvement in Saint Louis, MO

$150K - $200K(Ladders Estimates)

Lumeris   •  

Saint Louis, MO 63101

Industry: Healthcare

  •  

5 - 7 years

Posted 55 days ago

Position Summary:

The Director, Quality Improvement position is an important position within Lumeris, Inc., and a rare opportunity at an exciting time in US healthcare to make a tangible difference in several value-based care delivery models. A key client is the Essence Healthcare Plan, which is a 5 Star Medicare Advantage health plan primarily centered in the greater St. Louis, MO area. Other key clients include major payors looking to transition to value-based contracting with providers, and collaborative payors with their provider network.


For these clients, Lumeris is seeking a Director, Quality Improvement with Medicare Advantage Quality experience either from a payor or provider background and who is a seasoned business manager that can work with the growing staff of the Quality Improvement department, especially the three managers, to generate results. He/she needs to be skilled at motivating and leading through others, but also very willing to fill gaps and manifest an infectious accountability for her/his employees. This person will collaborate with and is guaranteed to receive training and support from senior management at Lumeris, as necessary.Job Description:

Role and Responsibilities

Management/Administration - People, Initiatives and Deliverables:


  • Leads and manages the daily operations of the Quality Improvement department, including staff hiring, orientation, supervision, monitoring of expenses, preparation of budgets, reporting of activities, achievement of objectives, addressing employee concerns, addressing performance and professionalism concerns, determination and facilitation of quality of care/service grievances, etc.
  • ·Closely collaborates with senior management, to drive key departmental initiatives
  • Develops, reviews or responds to project plans for key client initiatives related to the QI functions: Quality (to include HEDIS, HOS, CAHPS and Stars), Appeals, Grievances and Credentialing
  • Ensures and organizes internal and cross-departmental collaboration
  • Manages and facilitates initiatives to improve Health Plan Star Ratings and other national quality activities as appropriate
  • Represents or ensures appropriate representation of quality improvement functions at all internal quality committees, as well as during external regulatory, accreditation and other business functions
  • Performs or ensures staff perform program development, improvement and individual data management activities (e.g. CCIP/QIP as applicable, medical record review, coordination and implementation of quality initiative member outreach efforts, etc.)
  • Works in conjunction with Vice President of Quality and Chief Medical Officer to develop, implement and maintain a Quality Management Program (QMP) plan and Quality Management work plan with sufficient written policies and procedures to support the achievement of regulatory and payer contractual requirements and accreditation standards
  • Collaborates with key stakeholders across the organization to develop the strategic plan to foster organizational compliance with relevant current standards and requirements as well as assisting in the preparation for future activities to lay the groundwork to meet requirements necessary for NCQA and other accreditation
  • Organizes and represents the department during all CMS or other regulatory audits
  • Manages vendor relationships where appropriate for HEDIS or other activities

Technical Accountabilities:


  • Co-develops, implements and maintains systems, policies, and procedures for the identification, collection, and analysis of performance measurement data with Manager of Quality, VP of Quality Improvement and others
  • Provides administration of selected regulatory-required audits, (e.g., HOS, CAHPS, HEDIS) including contracting with vendors, training, supervision of activities, on-site audit, analysis of results, and develops and implements resulting corrective action plans
  • Reviews regulatory and contractual requirements and accreditation standards related to quality management to ensure compliance between standards and internal operations
  • Conducts review/audits of quality metrics for reporting to quality committees, and prepares

Experience, Qualifications, and Education

  • Master's degree in Healthcare Administration (will consider top performing candidates with Master's in Public Health or Business, as well) or Bachelor's degree with equivalent work experience
  • 5+ years of demonstrated management skills and results driven leadership
  • 5+ years of Quality Improvement experience in a Provider or Payor organization
  • 5+ years of performance improvement or quality improvement experience
  • Demonstrated professionalism and emotional intelligence
  • Ability to drive and facilitate collaboration across departments and with key organizational clinical leaders
  • Strong project management skills
  • Consistent focus on rolling up sleeves and working side by side with managers and individual contributors, as necessary, to support results and meet key deadlines and business objectives
  • Ability to assess the strengths and opportunities for each team member, business unit and department as a whole team
  • Strong ability to develop or replace employees with talent and attitude necessary for departmental success
  • Excellent verbal and written communication skills
  • Excellent Microsoft PowerPoint, Microsoft Excel, and Microsoft Word skills
  • Strong problem-solving skills
  • Ability to systematically analyze problems, draw relevant conclusions and devise appropriate courses of action
  • Strong analytic skills and ability to guide analysts
  • Ability to work with enterprise quality and performance improvement applications


Valid Through: 2019-10-14