Senior Director of Quality and Accreditation

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.

Washington, DC

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.

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Senior Director

Overview: <p>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.</p>
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>
Requirements: <ul> <li>BS/BA or RN and equivalent experience, advanced degree a plus.</li> <li>8-10 years of experience in leading an integrated and progressive quality organization, preferably within managed care industry.</li> <li>8+ years of significant leadership and managerial experience.</li> <li>Relationship focused.</li> <li>8+ years of experience with demonstrated functional knowledge, process improvement initiatives and organizational behavior.</li> </ul> <p><strong><u>SPECIAL KNOWLEDGE, SKILLS AND ABILITIES</u></strong></p> <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.</li> <li>Strong, independent decision maker and risk taker.</li> <li>Strong change management experience and demonstrated skills.</li> <li>Strong process and project management skills.</li> <li>Demonstrated staff development skills.</li> <li>Strong team building, collaboration and motivational skills.</li> <li>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> </ul>