Director, Provider Quality

About the role

This is a remote role with a preference for candidates to reside in the state of Indiana. The Director of Provider Quality will lead and collaborate on process improvement activities, NCQA Accreditation and HEDIS performance, risk adjustment processes, and STARS ratings for Medicare products. They will oversee provider satisfaction surveys, research best practices, and present results to senior management.

Responsibilities

• Lead and direct process improvement activities that provide more efficient and streamlined workflow.
• Engage network providers, collaborate with health systems, and support provider contracting and incentive programs.
• Collaborate with Medicare STARS team to improve overall STARS ratings for Medicare products (including HEDIS, CAHPS, HOS).
• Oversee provider satisfaction surveys and implement action plans for improvements.
• Research and incorporate best practices into operations.
• Organize and control activities, methods, and procedures to achieve business objectives.
• Review and implement new technological tools and processes.
• Foster a team concept with internal and external constituencies.
• Present results of improvement efforts and ongoing performance measures to senior management.
• Formulate and establish policies, operating procedures, and goals in compliance with internal and external guidelines.
• Oversee Coordinated Care's Cultural Competency Program, including its Cultural Competency Plan focused on Culturally and Linguistically Appropriate Services (CLAS).
• Lead Coordinated Care’s Health Disparities efforts, including those focused on justice involved individual members.
• Collaborate with State, County, and local agencies to promote services that improve health outcomes, decrease health disparities and reduce the cost of care.
• Monitor and evaluate provider practices through KPIs within health equity dashboards to assess and improve the cultural competence of delivered services by addressing care gaps and aligning interventions to resolve.
• Oversee the assessment of cultural diversity of the provider network to identify resources and gaps, including needs analysis for non-traditional providers (traditional healers, religious and spiritual resources, natural support systems, etc.) and develops recommendations for credentialing and network development activities.
• Oversee the population specific activities (such as training, awareness through the media, and partnering with various external equity stakeholders), including cultural treatment teams and other cultural community support system activities.
• Oversee the comprehensive, outcomes-based Cultural Competency Plan that is aligned with CLAS standards and national and regional priorities/initiatives.
• The plan also incorporates data-driven assessments of culturally competent performance, and defines a strategy for the continual provision, monitoring and improvement of culturally competent performance.
• Manage outreach budget for Cultural Competency programs and sponsorships.

Qualifications

• Bachelor's Degree in Nursing, other related field or equivalent experience required.
• Master's Degree preferred.
• 7+ years of quality management, quality improvement or healthcare operations experience required.
• Certified Professional in Health Care Quality preferred.

Skills

• Strong leadership and collaboration skills.
• Experience with process improvement and quality management.
• Knowledge of NCQA Accreditation and HEDIS performance metrics.
• Ability to manage and implement new technologies and processes.
• Excellent communication and presentation skills.
• Experience with health equity initiatives and cultural competency.

Benefits

• Competitive pay.
• Health insurance.
• 401K and stock purchase plans.
• Tuition reimbursement.
• Paid time off plus holidays.
• A flexible approach to work with remote, hybrid, field or office work schedules.