Job Summary:
The Director, Market Quality Improvement is responsible for directing activities to achieve defined quality goals and outcomes and improve quality performance for assigned market(s).
Essential Functions:
- Executes Quality Improvement program for assigned market(s) while ensuring that quality improvement goals, outcomes, and market compliance with NCQA accreditation and quality requirements, as well as state requirements, are met
- Develops, organizes, and monitors the Quality Improvement Program, Quality Improvement Plan and QAPI processes annually, and guides their implementation
- Annually collaborates with stakeholders, reviews, incorporates recommendations, and communicates the Quality Improvement Programto appropriate stakeholders by defined time limits
- Annually evaluates the previous year’s Quality Improvement Program to collaboratively develop the work plan for the upcoming year
- Analyze potential member risk data and quality data to improve quality performance and care for members across organizational lines of business
- Oversees and/or chairs workgroups and committees, to improve quality measure outcomes in their respective market
- Collaborates with business owners across the enterprise to successfully deliver quality related standards in compliance within defined timeframes
- Ensures quality requirements are met through continual review, audit and monitoring of quality improvement / performance improvement activities
- Responds to administrative inquiries related to quality issues or audits; oversees the development of corrective action plans, as needed
- Oversees analysis, including root cause analyses, with support from identified business owners and departments; ensures data is presented and used effectively to address quality and performance improvement identified issues
- Participates in community-based initiatives related to QI program initiatives
- Establishes and maintains standards and procedures for quality reporting and documentation and communicates areas of strengths as well as opportunities for improvement through the Quality Committees
- Externally represents CareSource to appropriate state-based committees, consultants, representatives, and accreditation authorities
- Oversees performance improvement projects as directed by state regulators
- Ensures compliance with regulatory quality reporting requirements and maintains an in-depth knowledge of the company’s business and regulatory and accreditation environments
- Aids in the budgeting and financial forecasting/ analysis process
- Assists in strategic planning and prioritizes staff workload
- Perform any other job related instructions, as requested
Education and Experience:
- Bachelor of Science in Nursing (BSN) or other degree in a healthcare, business, management or related field is required
- Masters in Nursing, Business, Management or related field is preferred
- Minimum of five (5) years of leadership/management experience is required
- Minimum of three (3) years of experience in Medicaid, or a managed care organization is required
- Minimum of five (5) years of healthcare quality experience to include developing, implementing and/or evaluating Quality Improvement Programs is required
Competencies, Knowledge and Skills:
- Experience in data collection, analysis and trending of processes and outcomes
- Intermediate computer skills; proficient in Microsoft Word, Excel, and PowerPoint
- Demonstrated understanding of complex healthcare industry, health plan and business processes specific to quality and performance Improvement, and quality methodology.
- Demonstrated experience in a high-growth business environment.
- Strong presentation skills
- Ability to work in a demanding environment and quickly reprioritize based on needs.
- Effective critical thinking skills with attention to detail
- Ability to develop, prioritize and accomplish goals.
- Effective communication skills (both written and verbal) and ability to work with multi-disciplinary departments across the organization to achieve goals that are dependent on multiple areas across the enterprise.
- Strong people skills and high level of professionalism
- Ability to work independently and within a team environment.
- Active listening and critical thinking skills
- Strategic leadership/management skills
- Customer service, member-focused orientation
Licensure and Certification:
- Certified Professional in HealthCare Quality (CPHQ) by the National Association for Healthcare Quality (NAHQ) within six (6) months of employment is required
Working Conditions:
- General office environment; may be required to sit or stand for extended periods of time
Compensation Range:
$113,000.00 - $197,700.00
CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.
Compensation Type (hourly/salary):
Salary
Organization Level Competencies
This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.
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