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Job Summary
This position is responsible for managing and directing clinical quality improvement and population health oversight activities, driving continuous quality improvement consistent with HCSC goals, regulatory requirements, and accreditation. The director will remain current with best practices and innovations in the areas of quality improvement, population health and clinical quality measurement, and provide guidance and support to local quality teams and HCM stakeholders. Fundamental to the role is a mastery of healthcare quality improvement methodologies and the measurement of healthcare processes and structures that contribute to primary and intermediary health outcomes. This person must possess extensive experience with HEDIS, NCQA, URAC, STARS, quality improvement, best practices, and innovative strategies to improve the quality of care and member experience; as well as a working knowledge of medical policy issues, condition management, and social determinants of health/health equity.Responsibilities include:
• Oversee a team responsible for evaluating and developing quality improvement and population health programs and initiatives that lead to improvements in clinical quality outcomes, with attention to care disparities and social determinants of health.
• Work with the Enterprise Quality Reporting (EQR) team to identify line of business and regional variations in clinical quality measures and population health statistics to inform targeted solutions.
• Collaborate with EQR to design, deliver and communicate reporting tools to support quality improvement and accreditation efforts.
• Work with the quality, data science and analytics teams to measure the impact of existing quality programs, design and communicate initiatives that effectively target variations in healthcare measures.
• Collaborate with Quality Operations team to coordinate quality improvement outreach efforts and initiatives and that support Accreditation Governance strategy.
• Partner with EQ&A and Quality Improvement Committee Meetings around quality best practices.
• Develop, review, and sign off on relevant policies and procedures.
• Maintain regular communication with management regarding developments within areas of assigned responsibilities and perform special projects as required or requested.
• Maintain currency with HEDIS, Hospital and other quality data sets, accreditation standards and a knowledge of marketplace, products, health care initiatives, technology, etc.
• Comply with HIPAA, Diversity Principles, Corporate Integrity, Compliance Program policies and other applicable corporate and departmental policies.
• Support and/or provide cross coverage in support of additional functions to ensure seamless execution of divisional priorities.
• Maintain complete confidentiality of company business.
• Other duties as assigned.
JOB REQUIREMENTS:
Bachelor’s Degree with 10 years’ experience in a healthcare insurance or provider setting in a quality improvement function or oversight role.
Clinical degree and/or formal training and leadership experience in public health, clinical research, or a healthcare-related field
5 years leadership/management experience
Proven track record in developing innovative quality improvement strategies.
Strong analytical, presentation & clear, concise verbal / written communication skills
Ability to adapt complex concepts to a range of audiences & express complex relationships in simple visual terms.
Executive presence with the ability to influence inside and outside HCSC.
Business and financial acumen; experience with operating, budgeting, and financial forecasting
Experience leading, formulating, and delivering strategy; building strong connections with people and team.
Ability to work effectively within a matrixed organization with multidisciplinary teams, across multiple geographic areas, with attitude toward team building.
Able to meet deadlines under pressure.
Willing and able to travel out of state.
PREFERRED JOB REQUIREMENTS:
RN or post-graduate education in Health Care Administration or a health-related field, public health and/or MBA.
extensive experience with HEDIS
Quality experience and Medical Management experience in a leading managed care/insurance or provider organization.
Health Informatics Training
Familiarity with clinical coding and statistical and reporting software.
Knowledge of health care reimbursement models.
Experience in provider and vendor negotiations and contracting models, provider relation and member services.
Familiarity with Government Programs, Stars ratings and Retail products
We encourage people of all backgrounds and experiences to apply. Even if you don’t think you are a perfect fit, apply anyway - you might have qualifications we haven’t even thought of yet.
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HCSC Employment Statement:
HCSC is committed to diversity in the workplace and to providing equal opportunity and affirmative action to employees and applicants. We are an Equal Opportunity Employment / Affirmative Action employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Drug screening and background investigation are required, as allowed by law. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.
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