Director of Quality HEDIS Operations, Texas South

About the Role

The Director Quality Operations provides strategic leadership and direction for the quality improvement program to the local market. This position works within highly matrixed relationships to develop and operationalize the overall quality strategy, ensuring the quality program is proactive, continuously improving, and includes quality management, improvement, and regulatory adherence. The role provides insight and direction to align with a changing healthcare landscape as it applies to quality, driving and executing strategy to ensure optimal HEDIS/CMS Star results.

Responsibilities

• Drives programs and initiatives to assure member access to care and gaps in care closure
• Partners with VP of Quality, QRA Medical Director, and local market cross-functional leadership to ensure established quality goals are met
• Manages assigned market/state Quality Improvement goals to drive and track data capture and collection, provider engagement and value-based contracting, member engagement programs, clinical, and customer care touch points
• Aligns and coordinates deliverables within their market/region and among the team, including but not limited to: CMS Star program, HEDIS data collection, Data Analytics and Reporting, CAHPS Member Surveys, HOS member surveys, ICD10/CPT/CPT II coding capture related to Quality initiatives, Regulatory Adherence, and Member/Provider Engagement
• Displays innovative problem-solving and upholds principles of continuous quality improvement
• Meets annual goals and objectives for the market and key metrics in conjunction with the VP of Quality, cross-functional teams, and corporate goals and strategies
• Monitors daily, weekly, monthly, quarterly, semi-annual, and annual reports against goals to assess program success and alignment, and to identify opportunities for improvement
• Accountable for and assists with Quality Strategy Business Plan
• Accountable for knowledge of Quality Improvement, CMS/Star Rating information and updates, NCQA/HEDIS, and gap metrics for assigned market
• Applies information to strategy to drive the market to excellence
• Performs all other related duties as assigned

Requirements

• 5+ years of significant and progressive leadership or managerial experience and responsibilities (management of process or discrete work stream is acceptable)
• 5+ years of experience in, and/or knowledge of, Clinical Quality and Quality Improvement processes required
• Experience with NCQA/HEDIS, CMS Star Program, ICD10/CPT/CPT II coding, and CAHPS/HOS
• 3+ years of management experience
• Excellent interpersonal skills
• Superior verbal and written communication skills; ability to convey complex or technical information clearly and concisely, as well as interpret complex information from others
• Proven problem-solving skills; ability to systematically analyze problems, draw relevant conclusions, and devise appropriate courses of action
• Performance-driven with exceptional analytical and data representation expertise
• Advanced knowledge of Microsoft Office applications, including Word, Excel, Visio, and PowerPoint
• Driver's license and access to reliable transportation

Preferred Qualifications

• Clinical Registered Nurse or other related clinical experience or education
• Certified Professional Healthcare Quality (CPHQ)
• 5+ years of experience working in managed care or a healthcare delivery system
• Project Management experience
• Solid knowledge base of clinical standards of care, preventative health, and STAR measures
• Solid financial analytical background within Medicare Advantage plans (Risk Adjustment/STARS Calculation models)

Physical & Mental Requirements

• Ability to lift up to 10 pounds
• Ability to sit for extended periods of time
• Ability to stand for extended periods of time
• Ability to use fine motor skills to operate office equipment and/or machinery
• Ability to receive and comprehend instructions verbally and/or in writing
• Ability to use logical reasoning for simple and complex problem solving

Pay

The salary for this role will range from $91,700 - $163,700 annually based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, and certifications.

Benefits

In addition to your salary, we offer a comprehensive benefits package, incentive and recognition programs, equity stock purchase, and 401k contribution (all benefits are subject to eligibility requirements).