Gold Coast Health Plan will not sponsor applicants for work visas.
The pay range above represents the minimum and maximum rate for this position in California. Factors that may be used to determine where newly hired employees will be placed in the pay range include the employee specific skills and qualifications, relevant years of experience and comparison to other employees already in this role. Most often, a newly hired employee will be placed below the midpoint of the range. Salary range will vary for remote positions outside of California.
POSITION SUMMARY
The Senior Director, Quality Data provides direction and supervision to the Quality Data team and leads all aspects of the Quality Data program and regulatory operations including vendor oversight, technical solutioning, data optimization, and management of strategic efforts to maximize quality results. The role has responsibilities that range from oversight of ensuring adequate claims and encounter data collection, establishing and supporting data solutions, as well as developing and maintaining strong relationships with providers to facilitate data integration and collaboration.
The Senior Director, Quality Data will deliver quality and value in a fast-paced, dynamic environment to support our Medicare and Medi-Cal programs through engaging in the transformation of clinical data to inform quality improvement efforts and strategic decision making, collaboration with partners across the organization and support of the HEDIS program and related activities. This will require building and maintaining strong relationships with IT, Operations, Network Management, Compliance, and provider partners.
This position requires demonstration of an elevated level of business acumen as well as cultivating and maturing partnerships within the organization.
Amount of Travel Required: 15%
ESSENTIAL FUNCTIONS
• The Senior Director, Quality Data will provide direction and supervision to the HEDIS and Quality Data teams.
• The goal is to drive superior quality measure performance scores for all lines of business (Medicare and Medi-Cal).
• The Senior Director will serve as an expert resource for quality measure specifications and will provide educational updates to Providers and clinical team members.
• The Senior Director will own all relationships with Quality Data vendors and ensure highest possible performance of those vendors.
• Partner with IT teams including Infrastructure, Engineering and Architecture to manage technical solutions to abstract, analyze and report national quality measure outcomes to regulatory agencies and quality improvement benchmarking platforms.
• The Senior Director will assure full use of available data resources to improve quality results.
• The Senior Director will assist the team in monitoring production, identifying inefficiencies, updating workflows, and managing the team.
• The overarching function of the Senior Director is to oversee team member outreach efforts, provide ongoing data evaluation and progress reports to the Chief Information & System Modernization Officer and to resolve any discrepancies that have been identified.
• Establish a robust balance and control framework to ensure the data Gold Coast provides to our partners is accurate, timely and complete.
• Provide Continuous monitoring of quality measure data (numerators and Denominators), identify data irregularities, monitor the Data Quality team and their projects.
• Evaluates quality measure data information and assists in establishing priorities for outreach efforts so that goals are achieved.
• Supervises data reporting and projects being completed by the team.
• Assists in the development of provider and care team directed education regarding quality measure specification details, changes and updates.
• Supports the development and implementation of new programs that may be innovative in their approach to maximize success with member outreach, closure of quality measure gaps and member satisfaction scores (HEDIS, HOS, CAHPS)
• Directs and supervises outreaches and activities regarding quality measure data.
• Ensures accuracy and compliance with all CMS and DHCS guidelines regarding quality measure sets.
• Collaborates with other departments for efficient and effective processing of HEDIS material for issues and outcomes.
• Coordinates care with appropriate functional areas (QI, SNP, HCS, and Pharm) for quality measure sets compliance.
QUALIFICATIONS
• Master’s degree in healthcare related profession.
• Experience leading quality data programs in a complex provider or health plan environment.
• Minimum of eight or more years of relevant experience in complex health care setting.
• Progressive management experience, with in-depth expertise in quality and process improvement methodologies, statistical analysis, and data base management.
• Expert working knowledge of current quality measures and data best practice in the healthcare industry demonstrated in recent professional experience.
• Demonstrated experience and demonstrated ability to improve quality measure performance, clinical, and analytics teams.
• Broad technology experience across several of key areas including cloud architecture, analytics, machine learning, DevOps, CI/CD, data quality management and digital transformation.
• Experience in the design and implementation of complex IT solutions (including scalable cloud-based solutions).
• Experience with large enterprise level systems and managing data at scale
• Experience with multiple public cloud providers (Azure preferred).
• Strong technical foundation with a solid background in architectural patterns involving Digital Experience Strategy and ability to map technology concepts across various technology platforms
• Strong computer, data analysis, communication, and project management skills.
• Comprehensive and thorough understanding of all elements of health care delivery, including strategy development, business planning, operations, and financial issues.
• Experience and ability to work effectively with all levels of organization, including department leadership, provider leadership, and other members of the medical staff.
• Possess a deep understanding of and expertise in the use of quantitative and qualitative measurements as they apply to analysis of practices, operational procedures, and revenue impact in relationship to quality outcomes.
PREFERRED QUALIFICATIONS
• PhD in Biostatistics or similar field
• Strong preference for experience leading a similarly structured team
• Strong preference for experience within a large, complex health system
• Ten or more years of relevant experience in complex health care setting
• Certifications in Cloud Technologies preferred (Azure Data Engineer, Solution Architect, etc.)
• Five or more years of manager (or higher) level experience in complex health care setting.
• Lean Six Sigma Black Belt Certification (LSSBB)
• Certified Professional in Healthcare Quality (CPHQ) or other related certification
