Director of Quality Initiatives - Managed Care
*** This is a Full Time, Direct Hire / Permanent opportunity! ***
Your Job Summary:
- Direct and monitor implementation of the Continuous Quality Improvement Program Description (QIPD) and Annual Workplan (QIWP) on a daily basis and provide routine reports to the Quality Executive Committee and Board of Directors.
- Lead / draft and secure required approvals for the annual quality improvement program evaluation (QIE), and update of the QIPD and QIWP in conjunction with the Chief Quality Officer and business leadership.
- Maintain knowledge base of NCQA, EQRO, CMS Core Measures, HEDIS, CAHPS and applicable District/State Medicaid contracts.
- Develop and provide training and access to resources to ensure all staff and key business owners are aware of the applicable quality standards, timelines, their roles/obligations and have access to reference materials and documents.
- Secure and collect documentation generated by all committees, sub-committees and workgroups within the Quality Improvement Committee structure. Consult with chairpersons and promote effective meetings that address quality standards/requirements, key metrics are used to important aspects of care/systems and reports to the Quality Executive Committee demonstrate outcomes/impact.
- Ensure that all organization and departmental quality related regulatory, contractual, accrediting body, EQRO and business timelines and deadlines are met.
- Maintain audit readiness. Coordinate with business owners on an ongoing basis to assess, design and redesign processes, policies and procedures and reports and secure documentation on an ongoing basis to maintain a constant readiness and proactive approach to meeting accreditation and external standards/obligations.
- Conduct ongoing and periodic gap assessments related to documented process, materials, reports and evidence of compliance available that meet NCQA, EQRO and other quality standards.
- Develop, maintain, oversee and communicate master project plans and strategic plans associated with, but not limited to, NCQA Health Plan Accreditation, NCQA CM Accreditation, EQRO, Performance Measure strategies, HEDIS, CAHPS and other business initiatives. Provide regular status reports to appropriate forums.
- Oversee HEDIS and CAHPS timelines and ensure results are communicated, action plans are implemented and followed-up in appropriate forums.
- Drive performance improvement and lead strategies to meet or exceed performance goals, especially related to HEDIS and CMS metrics.
- Communicate EQRO standards, perform gap assessments through business owners and department staff to monitor status of compliance and issues. Develop action plans as necessary and monitor resolutions.
- Coordinate the development, assign ownership, track deliverables and provide status reports on all quality related Corrective Action Plans.
- Oversee and facilitate effective, creative and meaningful Performance Improvement Projects that result in measurable performance outcomes. Meet required status report submission timelines.
- Develop and present reports that educate, inform and illustrate the scope and scale of quality initiatives and projects.
- Perform direct roles and supervision on the EQRO, NCQA, HEDIS and Regulatory reporting uploads and ensure all requirements are fulfilled timely and accurately.
- Secure and maintain the integrity of Quality Documentation and evidence of compliance to relative standards. Ensure document management is compliant with the corporate document retention policy.
- Maintain interactions and engagements with the highest ethical and professional standards. ▪ Provide input and participate in RFP processes as it applies to quality.
- This position will have direct reports, including clinical and non-clinical staff.
- Supervision of clinical staff by a non-clinical manager will require coordination with the designated clinical management resource.
- 5+ Years of Quality Improvement experience
- 3+ Years direct staff supervisory experience
- 5+ Years in the Health Care Industry with at least 2 years in Managed Care or Health Plans
- 2+ Years NCQA and/or HEDIS experience
- Medicaid Managed Care experience preferred
- BS or BA Degree in Nursing, Healthcare or Public Health
- BSN or MPH preferred
- DC RN licensure preferred
- Certified Professional of Healthcare Quality (CPHQ) Certification preferred