VP, Quality & Performance Outcomes

Job Summary:

Vice President, Quality and Performance Outcomes is responsible for overseeing the Healthcare Effectiveness Data and Information Sets (HEDIS) operations for all markets and products including setting strategies for maximizing STAR ratings, recognizing withhold dollars and reporting. Provides leadership to achieve target improvement goals.

Essential Functions:

• Establishes objectives and annual goals in conjunction with the Executive team
• Establish the organizations Quality structure and strategy in collaboration with the market
• Promotes organization-wide understanding, communication, and coordination of the Quality program
• Oversees the quality dashboard reporting and analyzes the validity of data/reports
• Ensures organization is compliant with NCQA Accreditation for products
• Provides leadership for and supervises the member/provider satisfaction survey process
• Provides leadership for the development, implementation, and evaluation of HEDIS strategy and action plans for all markets
• Work closely with the market CMO’s in jointly establishing goals
• Collaborate with the Enterprise clinical team and the markets in achieving the goals through evidence based interventions
• Developing health literacy campaigns jointly with the market leadership
• Supports External Quality Review Organization (EQRO) state audit processes
• Provides HEDIS/Quality leadership representation in new business activities
• Works with the Markets to establish their Quality structure & strategy
• Provides leadership support and makes recommendations for provider re-credentialing in the areas of medical record reviews, Clinical Quality indicators, performance and quality of care actions
• Assures compliance with all State and Federal HEDIS requirements
• Develops & manages the annual operating and capital budgets
• Oversees quarterly reporting of all HEDIS quality initiatives/results and state performance and bonus measures to all appropriate committees
• Develop the goals, measurements, quality standards and tracking mechanisms for HEDIS with DSI and clinical informatics
• Integrates HEDIS into provider strategy
• Perform any other job duties as requested

Education and Experience:

• Bachelor Degree or equivalent work experience is required
• Graduate degree in business administration (MBA), nursing (MSN), or public administration (MPA) preferred
• Minimum of ten (10) or more years of current progressive, operational experience in HEDIS, quality management, quality improvement, risk management, and/or utilization management in a managed care setting
• Five (5) years of strong senior level leadership/ management experience is required
• Demonstrated management of multiple regulatory and accreditation areas covering a broad range of populations
• Previous NCQA, URAC accreditation and HEDIS reporting knowledge and awareness is preferred
• Five (5) years of experience in a managed care organization, Medicaid, Medicare, and Long-Term Care is preferred

Competencies, Knowledge and Skills:

• Intermediate proficiency level with Microsoft Office (word, excel, PowerPoint) …