Senior Director, Quality Performance

Company:

Job Posting Location:

Job Title: ​

Job Description: ​

Position Summary: The Senior Director of Quality Performance will lead the organization's efforts in achieving excellence in Stars ratings, HEDIS measures, and clinical program development and execution. This senior leadership role will be responsible for strategic oversight, operational execution, and continuous improvement of our quality initiatives and clinical programs. The Senior Director will also oversee the development and implementation of the organization’s quality improvement strategy, ensuring alignment with organizational goals and regulatory requirements.

Key Responsibilities:

Strategic Leadership:

• Develop and implement strategies to enhance Stars ratings and HEDIS performance.
• Align quality improvement strategies with organizational goals and regulatory requirements.

Clinical Program Oversight:

• Lead the design, implementation, and evaluation of clinical programs aimed at improving patient outcomes and healthcare quality.

Quality Improvement:

• Drive continuous quality improvement initiatives across the organization.
• Utilize data-driven approaches to identify opportunities and implement solutions.

Team Management:

• Oversee and mentor a team of quality and clinical professionals, including Quality Managers and HEDIS Analysts.
• Foster a culture of excellence, collaboration, and accountability.

Stakeholder Engagement:

• Collaborate with internal and external stakeholders, including healthcare providers, health plan partners, and regulatory bodies.
• Support strong stakeholder collaboration related to the Stars program, HEDIS, Medication Adherence, and CAHPS.

Performance Monitoring:

• Establish and monitor key performance indicators (KPIs) for Stars, HEDIS, and clinical programs.
• Ensure timely and accurate reporting of quality metrics.

Regulatory Compliance:

• Ensure compliance with all relevant regulations and standards.
• Stay informed about CMS regulations related to quality measures.

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.

Other Job Functions:

• Understand, adhere to, and implement the Company’s policies and procedures.
• Provide excellent customer service skills, displaying awareness and sensitivity to the needs of internal and external clients.
• Take personal responsibility for growth, including acquiring new skills, knowledge, and information.
• Engage in excellent communication, including listening attentively and speaking professionally.
• Set and complete challenging goals.
• Demonstrate attention to detail and accuracy in work product.

Required Qualifications:

Education:

• Bachelor’s degree required.
• Advanced degree in healthcare administration, public health, nursing, or a related field preferred.

Experience:

• Minimum of 10 years of experience in healthcare quality management, with a proven track record of success in Stars and HEDIS performance improvement and clinical program leadership.
• 4+ years of experience in leading high-performing teams and managing people.
• Firm understanding of Stars, HEDIS, and CAHPS.

Skills and Abilities:

• Strong leadership and team management skills.
• Proficient in data analysis and interpretation.
• In-depth knowledge of healthcare regulations, standards, and best practices.
• Strong communication skills, both written and verbal.
• Ability to work with mathematical concepts and apply them to practical situations.
• Ability to apply principles of logical or scientific thinking to a wide range of problems.
• Proficient in Microsoft Office (Word, Excel, Outlook, PowerPoint)

Location: ​

Pay Range: ​

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.