Dir Quality Program Management

Cambia Health • Salt Lake City, UT

68d • $161,500 - $218,500 • Hybrid

About The Position

Cambia's dedicated team is living our mission to make health care easier and lives better. As a member of the Quality team, our Director Quality Program Management provides leadership for the development, implementation and management of clinical quality program management functions across all Cambia plans (includes quality outcomes, quality improvement initiatives, HEDIS, accreditation, delegation oversight and compliance functions)- all in service of creating a person-focused health care experience. As a people leader, you are willing to learn and grow, understanding that leadership is a craft that is continuously honed as you support your team and the lives that depend upon us.

Requirements

• Master's Degree in Healthcare, Nursing, Business or related field.
• 10 years of progressively responsible health care experience, 5 years in Quality Management, 5 years of management/leadership experience or equivalent combination of education and experience.
• Demonstrates ability to lead high performing teams, manage managers, and direct vendors.
• Strong communication and facilitation skills with all levels of the organization.
• Demonstrated ability to leverage AI tools and resources to drive efficiency and innovation within area of expertise.
• General business acumen including understanding of market dynamics, financial/budget management, data analysis and decision making.
• Knowledge of health insurance industry trends and technology.
• Knowledge of quality improvement theory, research design and statistics in the healthcare setting.
• Understanding of medical risk management.
• Demonstrates ability to create, advocate for and execute quality management programs that achieve desired outcomes targets and drive performance across internal teams, the delivery system and/or external vendors.
• Extensive knowledge of CMS and state regulatory requirements and demonstrated ability to manage compliant operations.
• Health Plan Accreditation (NCQA or URAC) and HEDIS measurement and reporting experience strongly preferred.
• Ability to decipher and interpret clinical data and deliver presentations to various internal/external audiences related to clinical outcomes.

Responsibilities

• Provides leadership in developing, implementing, and communicating short and long-range plans, goals, and objectives for the Quality Management function.
• Aligns team goals with the organization's vision and strategy.
• Manages the organization by ensuring clear performance expectations along with appropriate skills sets.
• Fosters an effective work environment and ensures employees receive recognition, feedback and development.
• Participates in organizational talent management and succession planning.
• Determines appropriate staffing levels and resource needs, creates and manages department and/or project budget, allocates resources, and approves expenditures.
• Ensures quality management programs achieve desired outcomes and meet federal and state regulations, accreditation standards, quality metrics, client requirements, and evolving models of care.
• Leads multi-functional team to assure compliance with accreditation standards.
• Ensures policies and procedures are updated timely as regulatory guidance changes and communicates/ensures necessary changes are implemented within impacted departments.
• Oversees regulatory and contract compliance within the Quality, Utilization Management and Care Management functions.
• Provides leadership in preparation for regulatory audits and accrediting surveys.
• Collaborates with Medical Directors, Health Informatics, Provider Services and other departments as needed to collect, analyze, and report on effectiveness of programs and address quality of care issues.
• Leads identification and implementation of quality improvement and population health programs that improve performance.
• Ensures education and training for leadership and staff and business associates as to the quality management plan and their respective responsibilities.
• Represents the organization in a variety of external forums focused on quality improvement.

Benefits

• Medical, dental and vision coverage for employees and their eligible family members, including mental health benefits.
• Annual employer contribution to a health savings account.
• Generous paid time off varying by role and tenure in addition to 10 company-paid holidays.
• Market-leading retirement plan including a company match on employee 401(k) contributions, with a potential discretionary contribution based on company performance (no vesting period).
• Up to 12 weeks of paid parental time off (eligibility requires 12 months of continuous service with Cambia immediately preceding leave).
• Award-winning wellness programs that reward you for participation.
• Employee Assistance Fund for those in need.
• Commute and parking benefits.

What This Job Offers

• Job Type: Full-time
• Career Level: Director
• Industry: Ambulatory Health Care Services
• Education Level: Master's degree
• Number of Employees: 5,001-10,000 employees