Director Strategic Quality Programs 8/9/2016
JOB DESCRIPTIONAPPLY POSITION SUMMARY:
The Director of company's srategic Quality Programs is responsible for developing, administering and managing Strategic Quality Programs in support of company's commitment to providing high quality care and service. Responsible for oversight of the organization's Medicare Stars Program, annual HEDIS Process and support of compliance, accreditation (NCQA for USFHP Program) and recognition standards. This role oversees and champions work related to the Health Plan's Triple Aim (Improving patient experience, population health and cost of health care) performance. Effective collaboration with leaders across the Martin's Point organization is critical to the success of these efforts.
Oversees Star Ratings strategy across the organization
Provides education, understanding and subject matter expertise regarding the measures and highlights the significant business impacts of improved ratings throughout the organization
Collaborates throughout the organization to implement processes/policies that ensure company requirements related to current and potential future Medicare Star Rating performance are in place
Coordinates activities throughout the organization to drive improvements in provider engagement, clinical care, data integrity, customer satisfaction, communication with members and providers
Supports analysis of Star rating elements
identifies opportunities for program improvements
designing and managing initiatives to support program improvements
analyzes financial impacts
Understands organizational clinical and operational activities related to Stars measures to ensure alignment and identify opportunities for collaboration Develops and maintains a vision for member engagement and coordinates strategies for member engagement and retention Analyzes metrics, summarizes key business learning, and translates into strategic plans Understands and interprets technical specifications for CAHPS, HOS, and HEDIS measures Manages external vendors for improvement activities Develops and implements systems, policies, and procedures for the identification, collection and analysis of performance measurement data, including preparation of routine core indicator reports, Stars Program related initiatives, annual HEDIS data collection and reporting, and special projects. Leads the annual HEDIS process, which includes, record retrieval and record abstraction processes, HEDIS Roadmap and prospective HEDIS activities. Educates and trains the leadership, staff and business associates as to the relevant areas of the quality improvement plan, and their respective responsibilities in carrying out the strategic quality programs. Leads, facilitates and advises internal quality improvement teams. Collects, analyzes and summarizes performance data, identifies opportunities for improvement, and presents findings to appropriate committees Researches and benchmarks industry performance metrics and best practices in quality related areas. Responsible for ensuring Senior Leadership is routinely updated on HP Quality performance through analysis and facilitating the creation of quality related dashboards. Works with HP Quality Programs manager to support accreditation processes to ensure company maintains continuous readiness for accreditation. Develops and implements annual operating plan and budget, ensures goals are met. Continually improves department processes and services. Participates in external professional organizations and committees. Monitors industry developments, trends, opportunities and uses this information to inform Strategic Quality Programs monitoring and product development
* Bachelor's degree in Health Care or Business Administration required. MHA, MBA or Clinical degree (RN, NP, PA, etc.) preferred
* 10+ years experience in health care. At least 8 of those years functioning in management/leadership roles within health care; including managing cross-functional teams and influencing without direct authority.
* Knowledge of Medicare Stars Program
* Knowledge of comprehensive HEDIS Process
* Experience leading accreditation and clinical process improvement efforts.
* Demonstrated knowledge of statistics, data collection, analysis and data presentation.
* Knowledge of federal and state laws and regulations and applicable accreditation standards.
* Demonstrates an understanding of and alignment with Martin's Point Values.
* Excellent interpersonal communication and problem solving skills.
* Excellent customer service focus: Team oriented individual with a high level of interpersonal skills, upbeat personality, and the ability to relate to all internal and external customers in a positive and professional manner.
* Strong track record of building internal and external collaborative relationships
* Familiarity with the fundamentals of Quality Management and Process Improvement is desired.
* Computer skills including Microsoft Word, Access, Excel, Visio, Outlook, and Internet.
* Proven history of being an effective team leader
* Fair and Flexible, High Ethical Standards
* Good at delegation of responsibility and establishing accountability.
* Able to set appropriate measureable targets and get results.
* Able to design work processes around customer needs and expectations, measure results, and improve systems when target not met.
* Applies proactive and innovative solutions to improve process effectiveness