Director, Quality Improvement

This is a remote opportunity supporting enterprise-wide quality strategy initiatives throughout the year. Experience with HEDIS operations and quality strategy initiatives is highly preferred.

Position Purpose:
Lead and direct process improvement activities that provide more efficient and streamlined workflow.

- Responsible for leading and collaborating with others on National Committee for Quality Assurance (NCQA) Accreditation and/or Healthcare Effectiveness Data and Information Set (HEDIS) performance

- Responsible for quality improvement aspects of risk adjustment processes for all products

- 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 and fosters 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

- For Coordinated Care – Washington – Director, Quality Improvement & Health Equity position only:

- 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.

- Work closely with State, County and local agencies, community stakeholders and communities to monitor the application of all standards

- Promote an environment of cultural competence throughout the health plan through identification and implementation of culturally-inclusive best practices and innovations, such as the development of provider trainings to improve cultural awareness and competency within the provider network

- 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.

- 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 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.

- Performs other duties as assigned.

- Complies with all policies and standards.

Education/Experience:

- Bachelor's Degree 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:

Pay Range: $118,400.00 - $219,000.00 per year

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