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VP of Quality

ExecuNet Houston Full-Time
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The Vice President, Quality will be a key senior leader in the Quality department / Houston Market. This leader will be responsible for identifying areas of opportunity and coordinating and implementing on this opportunity in conjunction with regional quality teams from a clinical first perspective. This position has responsibilities for Quality Performance Improvement activities for WellMed Medical Management across the Houston Market. May serve on multiple Optum Clinical and Quality Committees and leadership teams designed to provide strategic direction for all local care delivery groups within Optum.

Provides strategic direction, leadership, and oversight for Houston Market Quality performance and responsible for planning, organizing, and directing the administration of all Quality Programs. Provides leadership to, and is accountable for, the performance and direction through multiple layers of management and senior level professional staff. Responsible for coordinating with appropriate personnel to meet operational program needs, ensures compliance with state / federal health plan requirements, Medicare guidelines, HEDIS / STARS, CMS and health plan requirements. Provides long-term planning and oversight to ensure activities are appropriately integrated into strategic direction and operations, as well as the mission and values of the company.

The Vice President, Quality works closely and collaboratively with WellMed Executives, Houston Market Leadership, Quality Director of QRA, the existing quality team, and the rest of the regional leadership to achieve the goals and objectives of the QI / HEDIS program.

Lead as a clinician, putting patients first.

Primary Responsibilities

Quality Programs: HEDIS / STAR Performance Improvement and Clinic Ops Quality Improvement

  • End-to-end Strategy Deployment and Monitoring of all quality and pharmacy activities for the WellMed Houston Market; Function as a subject matter expert and provide leadership and support in establishing and directing the Houston Market Quality Program for WellMed
  • Develop and maintain policies / procedures that support the corporate initiatives for meeting State / Federal legal requirements and standards; Maintain current knowledge of regulatory requirements associated with the QI program
  • Provide vision and leadership to take the quality program under WellMed to the next level of service
  • Collaborate with physicians to execute the implementation of the clinical quality data initiatives as defined by Enterprise and Optum CDOs; Provide information / data as requested by leadership
  • Facilitate, integrate, and coordinate the implementation and evaluation of quality improvement / HEDIS activities as requested by UHG or related companies
  • Provide expertise to the training department on HEDIS / STAR measures and tools that support collection of and communication about HEDIS / STAR to the enterprise
  • Develop HEDIS / STAR member and provider engagement strategies to improve HEDIS, CAHPS, and HOS outcomes; Collaborate with WellMed executive team to execute HEDIS / STAR strategies
  • Work with Optum CDO Quality leadership team to provide HEDIS / STAR reporting and to develop strategic direction
  • Facilitate, integrate, and/or coordinate the implementation and evaluation of identified quality improvement / HEDIS / STAR activities as requested by UHG / UHC or related companies
  • Promote understanding, communication, and coordination of all quality improvement program components
  • Participate in requested evaluations and audits for UHC and other health plans
  • Coordinate reporting on quality initiatives to all appropriate committees
  • Assist with the development of the QM and UM Work Plan, Evaluation, and the monitoring of Work Plan activities as they relate to clinical Performance Improvement
  • Oversee HEDIS data submission process and lead accreditation efforts defined by the enterprise
  • Develop operating budget as necessary and participate on various teams, committees, and meetings at any level required to maintain business necessity
  • Maintain QI program documents, reports, and committee minutes and follow all internal privacy and confidentiality policies and procedures
  • Manage 2-3 direct reports with expectations to grow the team over time
  • Lead accreditation efforts as defined by enterprise
  • Direct medical / nursing / clinical best practice identification and standardization adoption in clinical settings with cross-functional teams and senior leaders
  • Build a more durable, integrated, unified Quality structure that will outlive any one individual’s tenure
  • Continue moving WellMed forward to capitalize on organizational success; Move the needle in the next 3 years

Pharmacy STARs Program

  • Direct quality initiatives as needed
  • Quality initiatives enterprise-wide (Part D measures)
  • Direct clinical cost of care strategies as needed
  • Pharmacy cost and utilization reporting, communications, and intervention programs (Anticoagulation clinic, CMTM)
  • Medical / Care management and clinical initiatives enterprise-wide (HEDIS / Star related measures)
  • Provide oversight for  injectable drug program under Part B
  • Medical necessity policies for key injectable drugs
  • Specialty pharmacy sourcing for injectable drugs
  • Clinical cost of care strategies for injectable drugs
  • Part B vs. D  audits 
  • Provide oversight for the management, compliance, implementation, and communication of the Medication Assistance Program (MAP)

Required Qualifications:

  • Registered Nurse (RN) degree with 10+ years of experience in practice
  • Master’s degree in Healthcare or Business Administration (10 additional years of comparable work experience beyond the required years of experience may be substituted in lieu of a Master’s degree)
  • Active and unrestricted license to practice in any US state with the ability to obtain a Texas license within 12 months of starting employment
  • Demonstrated knowledge of the business environment and business requirements (e.g., strategy changes, emerging business needs)
  • 10+ years of experience in managed care
  • 10+ years of senior management experience; Ability to manage up, laterally, and within non-traditional matrixed structures by influence
  • Extensive experience with quality improvement standards: NCQA, HEDIS, CAHPS, HOS, CMS
  • Proven capability to work with people at multiple levels within an organization; Prefer multiple locations, multi-function
  • Excellent training and collaboration skills
  • Excellent verbal and written communication, presentation, and facilitation skills; Presentation SME with market level interface
  • Visionary; This job is not just about doing the work – it is about building a vision
  • Knowledge of fiscal management and human resource management techniques; Proven evaluative and analytical skills with the ability to analyze data / reports and make recommendations
  • Exceptional organizational, detail, and accuracy skills
  • Strong team player with strong interpersonal and customer service skills
  • Proficient with Microsoft Word, Excel, and PowerPoint
  • Ability and willingness to travel both locally and non-locally as determined by business need

Skills required

Quality Management
Quality Assurance
Business Process Improvement
Performance Improvement
Process Management (Business)
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