Director, Health Plan Quality Program Management & Performance
New
J
JobgetherHealth plans
Based in United StatesFull-TimeDirector
Salary not disclosed
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Job Details
- Experience
- At least 8 years of healthcare experience, including a minimum of 5 years in health plan quality improvement, or an equivalent combination of relevant education and experience. At least 3 years of management or leadership experience.
- Required Skills
- Project ManagementData AnalysisMicrosoft Excel
Requirements
- At least 8 years of healthcare experience, including a minimum of 5 years in health plan quality improvement, or an equivalent combination of relevant education and experience.
- At least 3 years of management or leadership experience.
- Advanced knowledge of HEDIS and NCQA requirements, standards, and quality program practices.
- Experience with HEDIS reporting and data collection, CAHPS improvement initiatives, and state quality improvement programs.
- Experience working with Medicaid, Medicare, and Marketplace programs.
- Experience interpreting NCQA requirements and applying them to health plan operations.
- Experience supporting or leading NCQA accreditation surveys and audits, and audits focused on state contracts and regulatory compliance.
- Experience with Performance Improvement Projects and continuous quality improvement methodologies.
- Strong data analysis, interpretation, reporting, and data-driven decision-making capabilities.
- Strong critical-thinking, problem-solving, organizational, project management, and business writing skills.
- Proficiency with Microsoft Office, including Excel, and ability to learn new information systems and software.
- Preferred: knowledge of EPSDT and/or Texas Health Steps, provider credentialing or subcontractor monitoring experience, and CPHQ or CHCA certification.
- Preferred: Registered Nurse qualification; any license held must be active and unrestricted in the state of practice.
Responsibilities
- Lead the team responsible for health plan quality management and performance improvement activities.
- Develop and implement quality program strategies, including surveys, audits, performance improvement initiatives, and regulatory activities.
- Oversee quality program performance and compliance with health plan contracts, regulations, policies, and quality standards.
- Represent senior leadership at internal meetings and serve as a subject matter expert in state-level meetings and quality engagements.
- Oversee Performance Improvement Projects and apply quality improvement methodologies to drive measurable results.
- Collaborate with analytics and strategic teams to evaluate performance, interpret results, and communicate findings to leadership.
- Maintain quality program policies, procedures, governance, document management, reporting, and deliverable tracking.
- Prepare reports and documentation covering quality activities, feedback, outcomes, interventions, and remeasurement results.
- Lead training and education for quality management and performance staff.
- Hire, develop, coach, and manage team members, maintaining accountability for team performance and quality goals.
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