Director of Quality Management

We are looking for the best and the brightest problem-solvers who are dedicated to changing the way health care is delivered and are passionate about creating a better model for our national health care system. We offer a professional working environment, competitive salaries and excellent benefits. As we continue to grow, we are seeking an experienced Management Information System Director to join our Detroit, Michigan, office.

Detroit, MI

Healthcare Company

Our task is to make sure that you and your eligible family members are enrolled and receiving Medicaid or Alliance Benefits. Our mission is to help our D.C. neighbors receive the care and services needed to lead a long and healthy life.

keywords: relationships,strategy,leadership,quality assurance,solutions,analysis,creative,organization,communication,innovation,project management,technical,implementation,customer care,relationships,experience,analysis,performance,project management,knowledge,risk management,degree,language,technology,presentation,management


Overview: This position provides strategic leadership and direction for the quality improvement and management programs. The Director works within relationships to lead and develop the overall quality strategy for the plan, insuring the quality program is proactive, continuously improving, applies to all product and programs within the state, and includes both quality management/regulatory adherence and quality improvement. This position provides strategic insight and direction to the plan to align with a changing health care landscape as it applies to quality. The plan director is an active contributor in RFP responses, taking lead on the quality portion. This position develops and maintains strong relationships with state regulators, provides leadership input to expand and support provider engagement, and advocacy at the state level. This position coordinates across multiple functional areas including but not limited to: Clinical, Physician Engagement, Member Experience, Benefit Design/Product, Compliance, Network, Behavioral Services, and Pharmacy as needed to support the quality outcomes.
Responsibilities: <ul> <li>Oversees the development and implementation of plan quality program</li> <li>Works to coordinate the work within the Plan for: HEDIS Data Collection, Data Analytics and Reporting, Accreditation, Member Surveys, Regulatory Adherence, and Member Activation and Engagement. Utilizing the expertise, standard process, and capabilities of these areas to enhance quality program performance of the plan.</li> <li>Partners to develop Quality Improvement plan quality targets.</li> <li>Oversees and directs as applicable quality improvement activities and interventions to close gaps in care and improve outcomes for identified critical quality measures.</li> <li>Ensures strong HEDIS performance.</li> <li>Collaborates across business segments to attain or maintain the Plan&rsquo;s compliance with NCQA accreditation standards and contractual requirements as they apply to quality.</li> <li>Develops and maintains positive relationships with State Agency stakeholders and State External Quality Review Organization within the scope of Quality Management and Improvement.</li> <li>Oversees and insures the creation, integration, maintenance, approval, and submission of the trilogy document, including but not limited to Quality Program Description, Work Plan, Evaluation, and Program Policies and Procedures.</li> <li>Oversees and insures the creation and submission of reports to meet state contractual requirements including Performance Improvement projects (PIPs)</li> <li>Insures and oversees Health Plan Quality Management /committee structure and integrated quality oversight processes.</li> <li>Oversees and directs as applicable process improvement plans and corrective action plans for surveys, accreditations, EQROs, and state audits, within the scope of Quality Management and Improvement.</li> <li>Represents and gives input to the RFP process as it applies to quality.</li> <li>Interviews, hires, and supervises quality department staff.</li> <li>Develops, mentors, and coaches staff.</li> </ul> COMPETENCIES:<br /> <ul> <li>Analytical | Collects and researches data; Uses intuition and experience to complement data.</li> <li>Problem Solving - Identifies and resolves problems in a timely manner; Gathers and analyzes information skillfully; Develops alternative solutions; Works well in group problem solving situations; Uses reason even when dealing with emotional topics.</li> <li>Project Management | Communicates changes and progress; Completes projects on time and budget.</li> <li>Technical Skills - Assesses own strengths and weaknesses; Pursues training and development opportunities; Strives to continuously build knowledge and skills; Shares expertise with others.</li> <li>Customer Service | Manages difficult or emotional customer situations; Responds promptly to customer needs; Solicits customer feedback to improve service; Responds to requests for service and assistance; Meets commitments.</li> <li>Interpersonal Skills | Focuses on solving conflict, not blaming; Maintains confidentiality; Listens to others without interrupting; Keeps emotions under control; Remains open to others' ideas and tries new things.</li> <li>Oral Communication | Speaks clearly and persuasively in positive or negative situations; listens and gets clarification; Responds well to questions; Demonstrates group presentation skills; Participates in meetings.</li> <li>Written Communication | Writes clearly and informatively; Edits work for spelling and grammar; Varies writing style to meet needs; Able to read and interpret written information.</li> <li>Quality Management | Demonstrates accuracy and thoroughness.</li> <li>Diversity | Shows respect and sensitivity for cultural differences; promotes a harassment-free environment.</li> <li>Ethics | Treats people with respect; Keeps commitments; inspires the trust of others; Works with integrity and ethically; Upholds organizational values.</li> <li>Organizational Support | Follows policies and procedures; Completes administrative tasks correctly and on time; supports organization's goals and values; Supports affirmative action and respects diversity.</li> <li>Strategic Thinking - Develops strategies to achieve organizational goals; Understands organization's strengths &amp; weaknesses; Analyzes market and competition; Adapts strategy to changing conditions.</li> <li>Judgment | Displays willingness to make decisions; Includes appropriate people in decision-making process; makes timely decisions.</li> <li>Motivation | Sets and achieves challenging goals; Demonstrates persistence and overcomes obstacles.</li> <li>Planning/Organizing - Prioritizes and plans work activities; Uses time efficiently; Plans for additional resources.</li> <li>Professionalism | Approaches others in a tactful manner; Reacts well under pressure; Treats others with respect and consideration regardless of their status or position; Accepts responsibility for own actions; Follows through on commitments.</li> <li>Quality | Demonstrates accuracy and thoroughness; Looks for ways to improve and promote quality; Applies feedback to improve performance; Monitors own work to ensure quality.</li> <li>Safety and Security - Observes safety and security procedures; Reports potentially unsafe conditions.</li> </ul>
Requirements: <ul> <li>Performance Driven.</li> <li>Excellent written and oral communication skills with internal and external partners and employees.</li> <li>Strong influencing and negotiation skills. ▪ Strong, independent decision maker and risk taker.</li> <li>Strong change management experience and demonstrated skills. ▪ Strong process and project management skills.</li> <li>Demonstrated staff development skills.</li> <li>Strong team building, collaboration and motivational skills. ▪ Results-oriented.</li> <li>Expert knowledge of the managed care/health insurance industry, products and services (preferred).</li> <li>Comprehensive understanding of functional areas and the impact in performance and performance measurement of quality.</li> <li>CPHQ preferred.</li> <li>HEDIS Project Management</li> <li>NCQA experience&nbsp;</li> </ul> EDUCATION/CERTIFICATIONS: <br /> <ul> <li>BS/BA or RN and equivalent experience, advanced degree a plus.</li> <li>5-8 Years of experience in leading an integrated and progressive quality organization, preferably within managed care industry.</li> <li>5+ years of significant leadership and managerial experience. ▪ Relationship focused.</li> <li>5+ years of experience with demonstrated functional knowledge, process improvement initiatives and organizational behavior.</li> </ul> OTHER SKILLS:<br /> <ul> <li>LANGUAGE SKILLS | Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations. Ability to write reports, business correspondence, and procedure manuals. Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the public.</li> <li>MATHEMATICAL SKILLS | Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.</li> <li>REASONING ABILITY | Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.</li> <li>COMPUTER SKILLS | To perform this job successfully, an individual should have knowledge of ADP (TotalSource/ Workforce), Applicant Tracking System, (Tale, Workday) Database software; Outlook; Human Resource systems; Payroll systems; Spreadsheet software and Word Processing software.</li> <li>PHYSICAL DEMANDS | The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.</li> <li>While performing the duties of this job, the employee is regularly required to sit; use hands to finger, handle, or feel and talk or hear. The employee is frequently required to reach with hands and arms. The employee is occasionally required to stand; walk; climb or balance; stoop, kneel or crouch.</li> <li>The employee must regularly lift and/or move up to 10 pounds, frequently lift and/or move up to 25 pounds.</li> <li>Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus.</li> <li>WORK ENVIRONMENT | The noise level in the work environment is usually moderate.</li> </ul>