Director, Quality Improvement
Location: Orange, California US
Job Number: 3800
Position Title: Director, Quality Improvement
The Director, Quality Improvement is responsible for providing Medicare Star leadership around the member experience domain and for oversight of provider relations including timely and professional interactions with internal and external customers.
(May include but are not limited to)
- Responsible for oversight and success of member experience projects especially related to CAHPS.
- Set targets and priorities to meet national CAHPS and market-specific Medicare Star Program needs. Research issues related to measures not meeting benchmark and drive internal resolution.
- Collaborate with internal and external partners towards a comprehensive member experience strategy to positively impact member perception.
- Escalation of group performance issues including internal solutioning towards improved outcomes.
- Assures that workflows, policies, procedures, regulatory and accreditation standards are implemented, adhered to and met for JumpStart, disease management, case management, Special Needs Population (SNP) and other clinical programs.
- Collaborates with Medical Directors and Information Technology to develop and produce monthly quality outcome reports for the above.
- Identifies opportunities for improvement and coordinates strategy implementation with relevant stakeholders.
- Offers input and assistance with development of internal and external education and training programs for quality programs and metrics.
- Ensures that potential quality of care issues are addressed appropriately and resolved timely.
- Assists with annual quality related projects (internal evaluation, compliance plans, HEDIS, Stars, Satisfaction Surveys, etc.).
- Reviews, evaluates and develops policies, procedures, protocols and processes related to the organization’s quality projects and programs.
- Collects, evaluates, and analyzes clinical, functional and program data for patterns or trends in care delivery and reports findings to management.
- Other duties as requested or assigned.
- Establish clear team goals and expectations, set deadlines, and report team metrics to management.
- Proactively identify opportunities for additional coaching and training. Develop and maintain standardized training and reference materials to support uniform adoption of best practices.
- Motivate team to achieve goals and encourage creative thinking and new ideas.
- Assess workflows and implement process improvements to streamline team functions.
- Recognize and acknowledge the skills of team members and utilize their strengths to the benefit of the team.
- Provide constructive feedback to team members in a way that motivates and encourages high performance.
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- At least 3 years of experience with Medicaid and/or Medicare.
- A minimum of five years of relevant professional experience.
- Minimum Bachelor’s degree, Master’s degree preferred.
- Knowledge of Medicare Managed Care Plans, NCQA and HEDIS.
- Knowledgeable with CMS guidelines and regulations. Proficient in reporting and trending clinical outcomes and CMS required reporting.
- Personal computer experience should include working with Microsoft Word, Excel, PowerPoint and Outlook at the intermediate level at a minimum, as well as Visio, SharePoint.
- Bilingual (English/Spanish) preferred
- Ability to travel domestically (15-20%)
- Language Skills: Effective written and oral communication skills; ability to establish and maintain a constructive relationship with diverse members, management, employees and vendors.
- Mathematical Skills: Ability to perform mathematical calculations and calculate simple statistics correctly.
- Reasoning Skills: Ability to prioritize multiple tasks; advanced problem-solving; ability to use advanced reasoning to define problems, collect data, establish facts, draw valid conclusions, and design, implement and manage appropriate resolution.
- Problem-Solving Skills: Effective problem solving, organizational and time management skills and ability to work in a fast-paced environment.
- Report Analysis Skills: Comprehend and analyze statistical reports.
- Must be multi-task oriented and good with time management, well organized, and be able to work well under stringent timelines.
- Work Environment
- The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Essential Physical Functions:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.
- The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.
Location City: Orange
Location State: California
Community / Marketing Title: Director, Quality Improvement
Alignment Healthcare was founded with a mission to revolutionize health care with a serving heart culture. Through its unique integrated care delivery models, deep physician partnerships and use of proprietary technologies, Alignment is committed to transforming health care one person at a time.
By becoming a part of the Alignment Healthcare team, you will provide members with the quality of care they truly need and deserve. We believe that great work comes from people who are inspired to be their best. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment community.
EEO Employer Verbiage:
Alignment requires all new hires to follow local and/or state requirements regarding the COVID-19 vaccine and booster. If applicable, proof of vaccination and booster will be required as a condition of employment subject to legal exemptions. This policy, which Alignment reserves the right to modify, is part of Alignment’s ongoing efforts to ensure the safety and well-being of its staff and community and to support public health efforts.
Alignment Healthcare, LLC is proud to practice Equal Employment Opportunity and Affirmative Action. We are looking for diversity in qualified candidates for employment: Minority/Female/Disable/Protected Veteran.
If you require any reasonable accommodation under the Americans with Disabilities Act (ADA) in completing the online application, interviewing, completing any pre-employment testing or otherwise participating in the employee selection process, please contact firstname.lastname@example.org.
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