Director - Quality & Population Health

Description

• Put Patients First 
• Empower Entrepreneurial Provider and Care Teams 
• Operate with Integrity & Excellence 
• Be Innovative 
• Work As One Team 

What You'll Do

• Design and lead quality improvement strategies and programs across assigned business units and markets. 
• Develop and execute initiatives that improve care gap closure, member outcomes, provider performance, and quality ratings.  
• Collaborate with Quality, Risk Adjustment, Care Coordination, Clinical Operations, Population Health, Analytics, and Provider Relations teams to achieve organizational objectives.  
• Partner with Data Analytics teams to identify opportunities for quality improvement and performance optimization through actionable reporting. 

• Design and implement operational workflows supporting quality measure closure, care coordination, transitions of care, annual wellness visits, and engagement of high-risk populations.  
• Drive provider education and engagement initiatives that improve provider performance and adoption of value-based care programs.  
• Support health equity initiatives, Social Determinants of Health (SDoH) strategies, and population health management programs. 

• Lead and develop managers, supervisors, and team members while fostering a culture of accountability, innovation, collaboration, and continuous improvement. 
• Support mergers, acquisitions, integrations, and organizational growth initiatives by ensuring successful implementation and alignment of quality programs. 
• Be a culture-forward force for good 

Qualifications

• Minimum of 8 years of experience leading healthcare quality, population health, care management, delegated services, risk adjustment, or value-based care programs.  
• Minimum of 5 years of leadership experience managing managers, supervisors, and cross-functional healthcare teams.  
• Deep expertise in HEDIS, Risk Adjustment, Medicare Stars, CAHPS, HOS, Patient Safety, and NCQA quality programs.  
• Strong understanding of Medicare Advantage, Medicaid, Commercial populations, and value-based care models.  
• Demonstrated success developing and implementing quality improvement strategies that drive measurable outcomes. 
•  Experience partnering with providers, health plans, IPAs, ACOs, MSOs, or healthcare delivery organizations. 

• Certified Professional in Healthcare Quality (CPHQ), Registered Nurse (RN), or other relevant healthcare certification preferred.  

• Extensive knowledge of CMS, NCQA, health plan delegation requirements, and healthcare regulatory standards. 
• Strong analytical and operational leadership skills with the ability to translate data into actionable business strategies. 
• Expertise in quality measurement, population health management, care coordination, and value-based care programs. 
• Strong provider engagement and relationship management skills. 
• Excellent verbal, written, presentation, and executive communication skills. 
• Ability to influence stakeholders and drive results within highly matrixed organizations. 
• Proven leadership, coaching, team development, and change management capabilities. 
• Strong project management and strategic planning skills. 

• Experience leading Quality, Risk Adjustment, Care Coordination, Population Health, or Health Plan Delegation programs. 
• Experience managing quality initiatives within Medicare Advantage environments. 
• Experience with provider engagement, provider education, and provider performance improvement programs. 
• Experience supporting mergers, acquisitions, integrations, or new market expansion initiatives. 
• Experience managing vendor relationships and outsourced quality programs. 
• Experience with Health Equity, SDoH initiatives, and community-based population health programs. 

Environmental Job Requirements and Working Conditions

• Our organization follows a hybrid work structure where the expectation is to work both in office at least 3 days and at home on a weekly basis. The office is located at 8880 W Sunset Rd, Suite 320, Las Vegas NV 89148.
• The total compensation target pay range for this role is: $140,000 - $160,000. The salary range represents our national target range for this role.