Summary:

The Director, Quality Management is accountable for establishing and implementing an effective quality improvement program essential to meet state, federal and accreditation requirements. The incumbent is responsible for providing leadership to achieve accreditation and national best practice performance levels in quality improvement. The individual interfaces with a diverse range of clinical and administrative professionals, resolves complex policy and service issues and directs data analytic and reporting activities that are requested by customers and regulators.

• Responsible for NCQA readiness, accreditation, and ongoing compliance with NCQA requirements
• Facilitates strategic and tactical planning for the quality improvement program, including needs assessments, evaluations, root cause analysis and interventions.
• Serve as primary driver of Performance Improvement within the health plan, including committee oversight, work plans and annual evaluation.
• Establishes and implements governance and oversight of health plan quality program, including coordination of committee structure described in the health plan quality improvement program.
• Serves as primary leader and liaison with all departments to leverage and coordinate quality related resources and initiatives.
• Responsible for health plan's credentialing program operations.
• Provides primary oversight for quality initiatives that meet contractual requirements.
• Develops and implements programs and processes to achieve HEDIS and value-based purchasing program requirements.
• Establishes and implements initiatives to achieve maximum results from CAHPS, HOS and other member/provider satisfaction survey initiatives.
• Provides direction for the Quality Management Council in support of the Improvement Plan
• Coordinates all regulatory surveys and activities to include preparation and follow up, (i.e. DHA, CMS, HHSC) and others as required.
• Responsible for providing assistance to clinical and administrative staff in developing objectives, quality indicators, and goals that relate to quality performance in the respective departments
• Other duties as assigned by the health plans' Chief Medical Officer

Requirements:

Work Type: 

Full Time