Relocation Assistance Available

5+ to 7 years of experience

Management Experience Required

Bachelor's Degree

Job Description

The Director, Quality Improvement plans, develops, and directs the Quality Improvement functions.  The incumbent provides leadership necessary to achieve national best practice performance levels in quality improvement while implementing evidence based medicine/practices, ensures that the quality of healthcare services rendered meets or exceeds professionally recognized community standards, interfaces with a diverse range of clinical and administrative professionals, resolves sometimes-complex policy and service issues within the group and directs data analytic and reporting activities that are prescribed by customers and regulators in a multi-market environment, and ensures compliance with state, federal and accreditation requirements.

Develops and implements quality improvement plan in accordance with the mission and strategic goals of the organization, federal and state laws and regulations, and accreditation standards.

    Establishes professional relationships with state, stakeholders and community agencies to facilitate quality process internally and externally.

    Develops and implements systems, policies, and procedures for the identification, collection, and analysis of performance measurement data.

    Analyzes, updates, and modifies standard operating procedures and processes to continually improve QI Department services/operations.

    Assists in strategizing and facilitating various committee structures and functions to best address the QI process and oversees Quality Committees.

    Oversight and interface internally and externally with pay for performance programs and initiatives

    Coordinates and completes all QI activities required to meet national accreditation and regulatory performance improvement initiatives.

    Supervises member outreach coordinators with overall responsibility for providing support for clinical quality initiatives and regulatory/contractual requirements. Support includes telephonic and in-person outreach to members who are identified as requiring outreach services. In addition, to provide assistance to clinical compliance staff with member education classes, quality management, and Health Promotion initiatives and performance data collection and recording.

    Collects and summarizes regional market performance data, identifies opportunities for improvement, and presents findings quarterly to the Performance Improvement Committee

    Develops strategies for special program participation and Quality Improvement. Develops systems for close coordination of QI related functions with departments whose activities are directly a part of the QI Program, including Credentialing.

    Supervises QI Specialists in the implementation of performance initiatives to drive HEDIS performance and contract compliance quality performance.

    Communicates new state, federal and third party regulations and requirements to the staff.

    Facilitates strategic and tactical planning for the quality improvement program, including needs assessments, evaluations, root cause analysis and interventions.

    Collaborates with Health Services, Operations, and Information Technology departments to ensure full integration of quality improvement reporting for contract and accreditation compliance

    Participates in site visit preparation and execution by regulatory and accreditation agencies (state agencies, URAC, NCQA, CMS, AAAHC, EQRO)

    Leads, facilitates, and advises internal quality improvement teams

    Actively participates on, or facilitates committees such as: Quality Improvement, Utilization Management, Patient

    Safety, and Risk Management

    Responsible for monitoring and evaluating staff performance.

    Performs other duties as assigned

Qualifications

 Education:  A Bachelor's Degree in Healthcare, Nursing, Health Administration or related field; Master's Degree in Healthcare preferred                                                        

Experience:

    10+ years of quality improvement experience

    5+ years in managed healthcare

    Excellent knowledge of JCAHO, URAC, AAAHC and NCQA standards

    2+ years with Medicaid experience

    3-5 years management experience

 Licenses/Certifications:

    Master's Degree in Public Health preferred

    Registered Nurse with active licensure preferred

    Certification in Healthcare Quality by the Healthcare Quality Certification Board, or equivalent preferred

Special Skills (e.g. 2nd language):

    Excellent understanding of accreditation, federal and state regulations/requirements

    Excellent verbal and written communication skills

    Strong analytical and problem solving skills

    Ability to communicate effectively with people with varying levels of education

    Ability to multitask in a fast paced environment

Technical Skills/Requirements:  Proficient in Microsoft Office such as Excel, Word, Visio, PowerPoint and Outlook