Director, Quality Performance / Job Req 956626885

Hybrid: Applicants must be a California resident as of their first day of employment.

PRINCIPLE RESPONSIBILITIES:

Under the general direction of the Senior Director, Quality, the Director, Quality Performance is responsible for developing, coordinating, implementing, and managing the strategic quality performance programs across multiple lines of businesses including Medi-Cal, Dual Eligible Special Needs Program (D-SNP), and Group Care). This role will work cross-functionally to implement quality initiatives to achieve state and national benchmarks for National Committee for Quality Assurance (NCQA) Healthcare Effectiveness Data and Information Set (HEDIS), Centers for Medicare & Medicaid (CMS) Star Ratings, Department of Health Care Services Medi-Cal Managed Care Accountability Set, and Department of Managed Health Care (DMHC) Health Equity and Quality Measure Set. The Director, Quality Performance is expected to collaborate with internal teams, provider networks, and with senior clinical leadership to drive initiatives and ensure oversight of medical management in accordance with regulatory requirements, accreditation standards, clinical outcomes, and member experience

Principle responsibilities include:

• Develop and execute a comprehensive quality performance strategy, aligned with regulatory requirements, in partnership with the Director, Star Strategy and Program Management and QI Medical Director
• Design and implement programs to improve HEDIS, CAHPS, and Star Ratings performance, ensuring alignment with NCQA, CMS, and DHCS standards
• Oversee and maintain a robust data-driven quality measures program by developing dashboards and reporting tools to track quality performance of targeted initiatives, identify gaps, and inform decision-making
• Monitor and report on quality measure performance and initiatives to Quality Improvement Committees and relevant sub-committees
• Develop innovative strategies to improve and sustain HEDIS, CAHPS, and Star Ratings performance through on-going engagement with internal stakeholders, provider networks, members, and community partners
• Develop or maintain policies and procedures, standard operating procedures, and trilogy documents (i.e. program description, workplan, evaluation) for the D-SNP Quality Management program
• Work cross-collaboratively with clinical teams to review, update, and implement the D-SNP Model of Care
• Partner with clinical leadership for coordination and administrative oversight of clinical responsibilities to ensure compliance with regulatory requirements and accreditation standards
• Provide operational oversight of quality improvement processes including site visits, quality monitoring activities for skilled nursing or long-term care facilities, and medical chart audits
• Serve as a resource for the design and evaluation of process improvement plans/quality improvement plans, and ensure they meet Continuous Quality Improvement (CQI) methodology and state contractual requirements
• Ensure compliance with CMS, DHCS, and other relevant regulatory agencies by maintaining up-to-date knowledge of quality and performance measurement standards

ESSENTIAL FUNCTIONS OF THE JOB:

• Assumes responsibility and exercises good judgement in making decisions within the scope of authority of the position.
• Proficient in understanding the NCQA technical specifications as it relates to HEDIS measures and their impact to Star ratings methodology.
• Demonstrates strong organizational, time management, and project management skills and multi-tasking abilities.
• Proven track record of developing and implementing successful HEDIS and member experience interventions with a focus on improving Star ratings.
• Provides support to the Project Management Office (PMO) and various enterprise-wide activities based on availability.
• Organizes and facilitates HEDIS, Stars, quality improvement, project-related meetings, as necessary.
• Works effectively independently as well as part of a team and supports team decisions.
• Adapts to changes in requirements/priorities for daily and specialized tasks.
• Produces accurate and precise work, detects discrepancies, and resolves discrepancies all while meeting deadlines.
• Demonstrates analytical skills and problem-solving skills as well as formulates and communicates recommendations for improvements as needed.

PHYSICAL REQUIREMENTS:

• Constant and close visual work at desk or computer.
• Constant sitting and working at desk.
• Constant data entry using keyboard and/or mouse.
• Frequent use of telephone headset.
• Frequent verbal and written communication with staff and other business associates by telephone, correspondence, or in person.
• Frequent lifting of folders and various other objects weighing between 0 and 20 lbs.
• Frequent walking and standing.
• Occasional driving of automobiles.

Number of Employees Direct Supervision: 3-10

Number of Employees In-Direct Supervision: 10-15

MINIMUM QUALIFICATIONS:

EDUCATION OR TRAINING EQUIVALENT TO:

• Master's degree in a health care field (i.e. nursing, health sciences/administration) strongly preferred.
• Requires a BA/BS in a health care field (i.e. nursing, health sciences)

MINIMUM YEARS OF ADDITIONAL RELATED EXPERIENCE:

• Minimum of 7-10 years of experience in management roles in a health care setting, including at least:

o 3 years of quality leadership and management experience in a managed care health plan setting.

• Medi-Cal and Medicare Advantage D-SNP experience is strongly preferred.
• Experience with Quality measures reporting is strongly preferred.

SPECIAL QUALIFICATIONS (SKILLS, ABILITIES, LICENSE):

• If a RN, must have an active and current non-restricted CA license
• Ability to work collaboratively with physicians, staff, and external organizations to improve quality outcomes.
• Strong regulatory audit experience including organized approaches for continuous readiness, monitoring, and actions to comply with State and Federal mandates or regulations.
• Robust ability to lead and train staff in various quality improvement and performance improvement methodologies and overall nursing licensure needs.
• Strong communication and presentation skills, training/meeting facilitation skills a plus
• Solid relationship building and interpersonal skills.
• Excellent writing, research, analytical, and time management skills.
• Excellent coordination skills, including multi-tasking and setting priorities on work assignments.
• Ability to organize and coordinate various activities involved in a research, collaborative and demonstration project.
• High degree of independence, flexibility, initiative and commitment.
• Ability to work effectively with diverse populations, both internally and externally.
• Solid critical thinking and problem-solving skills.
• Ability to utilize sound judgment and promptly report potential risks.
• Ability to work in a fast paced, patient-service oriented environment.
• Demonstrate sound ability to promote quality improvement through development and maintenance of standards.
• Must handle PHI and maintain confidentiality at all levels.
• Proficiency in Windows including Microsoft Office suite including Word, Excel, and PowerPoint

SALARY RANGE $167,440.00 - $251,160.00 ANNUALLY

The Alliance is an equal opportunity employer and makes employment decisions on the basis of qualifications and merit. We strive to have the best qualified person in every job. Our policy prohibits unlawful discrimination based on race, color, creed, gender, religion, veteran status, marital status, registered domestic partner status, age, national origin or ancestry, physical or mental disability, medical condition, genetic characteristic, sexual orientation, gender identity or expression, or any other consideration made unlawful by federal, state, or local laws. M/F/Vets/Disabled.