Quality Improvement Director

Become a part of our caring community   The Director, Quality Improvement leads the development, implementation, and evaluation of quality improvement programs across all lines of business, including the annual program description, work plan, and annual evaluation. You will have accountability for quality withhold performance, including monitoring results, identifying improvement opportunities, and driving strategies to optimize performance outcomes. The Director partners across matrixed and cross-functional teams, including teams outside of the direct reporting structure, to improve market quality goals and ensure agreement on priorities. We ask that you have deep expertise in HEDIS, CAHPS, and performance improvement, as well as the ability to lead teams and influence stakeholders across the organization. The QI Director supports resolving complex technical and operational problems within department(s) and leads multiple associates and highly specialized professional associates. The Director, Quality Improvement leads quality investigations, compliance oversight, and quality improvement operations across all lines of business. This role is accountable for the administration of the quality management system. It is also responsible for oversight of department reporting and documentation platforms. Furthermore, the role executes audit and monitoring activities to ensure compliance with internal, state, and federal requirements. The Director also has responsibility for quality withhold performance, including monitoring results, identifying gaps, and driving improvement strategies to support achievement of enterprise quality goals. You will support NCQA accreditation and will serve as the local market lead for accreditation compliance. You will ensure accurate and timely preparation and submission of required reports to all regulators. You will collaborate across matrixed and cross-functional teams, including those not directly led by the incumbent, to support implementation of new and revised programs, large-scale initiatives, and operational process improvements. You will exercise broad decision-making authority related to program execution, technical and operational procedures, and performance optimization, while contributing to functional strategy and advancing organizational goals. We are looking for commitment to cross-functional collaboration to drive continuous quality improvement throughout health plan operations, provider network and community partnerships to achieve our quality improvement goals and objectives. Additional Job Description Direct HEDIS project deliverables, driving results and improvement by population stream. Align Quality and Population Health strategies. Provide strategic oversight of Cross-stream Quality Withhold collaborative efforts. Direct efforts on maintaining quality documentation including policies/procedures, committee minutes/materials, and program documents. Provide oversight of the Annual Quality Program Description, Annual Quality Work Plan, and the Annual Quality Program Evaluation. Directs efforts on maintaining NCQA and EQRO compliance. Maintain confidential information in accordance with policies, and state and federal laws, rules, and regulations regarding confidentiality. Oversee the development, implementation and management of quality improvement projects including required contract required Performance Improvement Projects (PIPs) Work collaboratively with OHCA and others to improve health outcomes. Oversee HEDIS, CAHPS, and OHCA required measure reporting and evaluation. Improve quality measure performance through innovative approaches in engaging members and providers. Analyze dashboards consisting of Key Performance Indicators (KPI), and non-KPI metrics, interpreting trends and significant variances as opportunities to improve outcomes. Incorporate actionable analytics, using business intelligence tools, care coordination tools, and claims systems to identify issues, mitigate