Title: Vice President, Quality & Process Improvement (Health Plan)
As the senior leader, reporting to the Health Plan CEO, you will be responsible for developing and overseeing the quality improvement programs and strategies for the business unit.
To be part of the leadership team to assist and develop the strategic mission and vision of the business unit
To identify and implement the selection of process improvement activities across the organization of this Fortune 100 company.
Driving performance improvement for HEDIS, Stars, State Contract Quality & Pay for Performance/Withhold, and Marketplace QRS
Medicare Quality metrics and processes
Other quality improvement opportunities
Develop infrastructure and processes for management of activities related to National Committee for Quality Assurance (NCQA) Accreditation and Healthcare Effectiveness Data and Information
Set (HEDIS) performance ensuring the highest level of accreditation
Oversee the development and implementation of enterprise-wide and market-specific process improvement programs
Review and present results of quality interventions for clinical and operational performance improvements and identify organizational risks to executive management
Develop and ensure consistent, reliable and valid application of data collection and analysis for priority performance measures, including HEDIS, pay for performance and contractual performance measures
Review and analyze cost-benefit and return on investment analyses for organizational resource allocation and recommend action plans
Responsible for building relationships and positioning MHS as the “go to” source for state of the art MCE Quality Metrics.
Bachelor's degree in healthcare or related clinical field.
Master's in Business Administration preferred.
10+ years of healthcare operations experience including, quality and process improvement experience.
Experience with NCQA accreditation preparation and auditing, including the analysis of HEDIS performance measures.
Certified Professional in Health Care Quality (CPHQ).
RN License preferred.
Compensation: Substantial base salary with 20% or higher Bonus
and Generous Relocation
package will be offered to the right candidate.