Director, Quality Improvement

Job Number: 3800

Workplace Type: Hybrid Remote

Position Title: Director, Quality Improvement

External Description:

Position Summary:
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.

 

General Duties/Responsibilities:

(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.

 

Supervisory Responsibilities:

• 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.

 

Minimum Requirements:

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.

 

Minimum Experience:

1. At least 3 years of experience with Medicaid and/or Medicare.
2. A minimum of five years of relevant professional experience.

 

Education/Licensure:

1. Minimum Bachelor’s degree, Master’s degree preferred.

 

Other:

1. Knowledge of Medicare Managed Care Plans, NCQA and HEDIS.
2. Knowledgeable with CMS guidelines and regulations. Proficient in reporting and trending clinical outcomes and CMS required reporting.
3. 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.
4. Bilingual (English/Spanish) preferred
5. Ability to travel domestically (15-20%)
6. Language Skills: Effective written and oral communication skills; ability to establish and maintain a constructive relationship with diverse members, management, employees and vendors.
7. Mathematical Skills: Ability to perform mathematical calculations and calculate simple statistics correctly.
8. 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.
9. Problem-Solving Skills: Effective problem solving, organizational and time management skills and ability to work in a fast-paced environment.
10. Report Analysis Skills: Comprehend and analyze statistical reports.
11. Must be multi-task oriented and good with time management, well organized, and be able to work well under stringent timelines.

1. Work Environment
1. 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.

 

1. 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.
2. 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.

City: Orange

State: California

Location City: Orange

Location State: California

Community / Marketing Title: Director, Quality Improvement

Company Profile:

By leveraging our world-class technology platform, innovative care delivery models, deep physician partnerships and our serving heart culture, Alignment Health is revolutionizing health care for seniors! From member experience professionals and clinicians, to data scientists and operations leaders, we have built a talented and passionate team that is deeply committed to our mission of transforming health care for the seniors we serve. Ready to join us?

At Alignment, delivering exceptional care to seniors starts with ensuring an exceptional experience for our over 1,300 employees. At the center of our employee experience is a culture where employees at all levels and across all teams are encouraged to share their unique ideas and perspectives. After all, when you can bring your authentic self to work, whether that’s in a clinical setting, our corporate office or a home office, creativity and innovation flourish! Another important part of the Alignment culture is a belief in continuous learning and growth. As a result, in this fast-growing company, you will find ample support to grow your skills and your career – with us.

EEO Employer Verbiage:

 

Please note: All clinical positions are contingent upon successful engagement with Alignment Health’s COVID-19 Vaccination program (fully vaccinated with documented proof or approved exception/deferral).

Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.

*DISCLAIMER: Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Please be advised that Alignment Health and its subsidiaries will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at https://reportfraud.ftc.gov/#/. If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health’s talent acquisition team, please email [email protected].