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Director, Quality

Director, Quality
Job Details
Job Type

Full-time

Greensboro, NC • Quality
Description
Job Summary

The Director for Quality is responsible for developing, administering, and managing the Medicare Stars program, and other quality improvement processes and programs (HEDIS, CAHPS, and HOS) to support the objectives of providing high-quality care and service to our members. The Director is responsible for strategic planning and contributes knowledge to assist the executive team in the decision-making process for future strategies. The Director oversees the delegated partners to ensure that program objectives are met. Working across the company, the Director will identify, direct and lead programs to achieve the company desired Star ratings and quality incentive bonus program improvements; and all processes are in compliance with applicable laws and regulations.

Major Work Activities

Collaborates with executive leaders and outside agencies/vendors regarding strategic planning and execution of various quality projects. Strategically conceptualize future tools and processes for the success of HTA and maintain focus on outcomes. Serves as a resource for multiple committees within HTA and third-party vendors regarding quality and Stars. Directs implementation of the strategic plans for quality programs (including Stars, HEDIS, CCIP), including improved approaches to structure and effectiveness for processes
Leads and directs the quality programs to continually assess the tactical processes to achieve program objectives; identifies and quantifies key drivers of the Star measures and Display measures; identify areas of opportunity and improvement; and creates programs to address each
Supports and oversees the implementation of work plans establish deadlines, assigns responsibilities, monitors project progress, and reports progress regularly to internal stakeholders for the Stars Program, Healthcare Effectiveness Data and Information Set (HEDIS), Health Outcomes Survey (HOS), Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys
Oversees the relationship with vendors including performance oversight, quality reviews, corrective actions (and education and training) to improve performance and/or compliance with regulations, and ensures all required reporting is accurate, timely, and complete.
Oversee daily operations of HTA staff which includes performance improvement and quality. Ensure data is accurate, reliable, and valid for reporting purposes either to HTA leaders, providers, or other outside entities. Collaborate with leaders of all levels to ensure consistency of priorities in quality and to ensure alignment of quality goals. Direct processes and standards that support business goals. Oversee, ongoing monitoring of governmental changes in reporting and quality metric criteria that is HEDIS, Star, and Plan related.
Supports and oversees the development of quality improvement initiatives, Chronic Care Improvement Projects (CCIP) for Medicare Advantage Organizations. Collects, analyzes, and summarizes information and trends, consults on research projects, and recommends actions to improve quality measures in support of Star rating goals.
Oversees the build and maintenance of education programs for physicians by delegated partners to ensure the plan goals are communicated appropriately
Works collaboratively across the organization to lead quality initiatives and support compliance/audit requirements as needed
Develops, analyzes, and communicates regular reporting on key performance metrics to leadership
Leads staff assigned to Medicare Stars, HEDIS; provides guidance and mentoring of staff; and builds effective teams (both internally and with vendors) to achieve established goals and within established budgets
Demonstrates the ability to lead and influence others positively to achieve desired goals of HTA
Performs other duties as assigned



Requirements
Minimum Qualifications

Required Education

Bachelor’s Degree required in Healthcare or Business-related fields or years equivalent work experience

Required Licensure/Certification

Clinical Licensure

Annual Flu Vaccine

COVID-19 Vaccine

Required Experience

Post Graduate Residency or 5+ years equivalent healthcare experience
Knowledge of the HEDIS process and measure experience
Five plus years of experience working in a healthcare setting with a focus on monitoring and analyzing projects
Two plus years of Managed Care or Accountable Care Organization experience
Two plus years of experience with the Medicare Stars program and improvement strategies
Five plus years’ Experience with vendor oversight
Proficient in Word, Excel, and PP
Required Knowledge, Skills, and Abilities

Working knowledge of HEDIS, CAHPS, HOS, and NCQA
Working knowledge of Medicare Advantage and Part D laws and regulations
Strong in the following competencies:

Decision making/Judgment
Problem solving/Analysis
Communication
Creativity/Innovation
Preferred Education

Master of Health Administration, Master of Business Administration or Pharmacy Administration, or other advanced degree in pharmacy or healthcare leadership

Preferred Experience

Experience working with regulatory agencies (CMS)
Five plus years of Managed Care Organization or Accountable Care Organization experience
Experience leading/ coordinating initiatives
Experience performing clinical data analysis
Preferred Knowledge, Skills, and Abilities

Familiarity with ICD-10

Time:  Full time
Salary:  Salary
Category:  Clinical/pharmacy/quality

Updated: 4/19/2022 10:25:05 AM