The Director of Quality Performance is responsible for the development and implementation of the organization’s quality improvement strategy. They will lead the day-to-day operations of the quality program and support strong stakeholder collaboration with all things related to the Stars program including HEDIS, Medication Adherence and CAHPS. The Director of Quality Performance will oversee process improvement activities, health plan engagement, patient experience, quality data ingestions, submissions, analytics and reporting.
Essential Job Functions:
Quality Improvement Strategy:
Develop, implement and execute a comprehensive quality improvement strategy aligned with organizational goals.
Collaborate with cross-functional teams to enhance clinical outcomes, patient satisfaction, and overall quality of care.
HEDIS and Stars Performance:
Manage HEDIS and Stars data collection, reporting, and analysis.
Drive initiatives to improve HEDIS and Stars scores, ensuring compliance with national benchmarks.
Implement evidence-based practices to enhance preventive care, chronic disease management, and member engagement.
Leadership and Collaboration:
Lead and manage a team of quality professionals, including Quality Managers, and HEDIS Analysts,
Collaborate with clinical leaders, providers, and network partners to align quality goals and drive performance improvement.
Risk Adjustment and Coding Accuracy:
Work closely with coding teams to optimize risk adjustment and quality processes.
Quality Metrics and Reporting:
Monitor and report on key quality metrics, identifying trends and areas for improvement.
Present findings to executive leadership and recommend actionable strategies.
Regulatory Compliance:
Stay informed about CMS (Centers for Medicare & Medicaid Services) regulations related to quality measures.
Ensure compliance with all relevant guidelines and requirements.
Required Qualifications:
Minimum Experience
10+ years of experience in quality management, quality improvement, or healthcare operations.
4+ years’ experience in leading high performing teams and managing people
Must have firm understanding of Stars, HEDIS and CAHPS.
Must be analytical
Must have excellent collaboration and communications skills and can influence change across teams
Understand medical records or have ability to read clinical records
Education/Licensure:
Bachelor’s degree required
Master’s degree preferred
Salary range shown is a guideline. Individual compensation packages can vary based on factors unique to each candidate, such as skill set, experience, and qualifications.
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