Director Market Quality Improvement(Ohio Residency Required)

CareSource•Dayton, OH

2d•$113,000 - $197,700•Onsite

About The Position

The Director, Market Quality Improvement is responsible for directing activities to achieve defined quality goals and outcomes and improve quality performance for assigned market(s). This role executes the Quality Improvement program for assigned markets, ensuring compliance with NCQA accreditation, state requirements, and quality goals. The Director develops, organizes, and monitors the Quality Improvement Program and Plan annually, collaborating with stakeholders and evaluating previous programs to develop future work plans. Key responsibilities include analyzing member risk and quality data, overseeing workgroups and committees to improve quality measure outcomes, and collaborating with business owners to ensure quality standards are met. The role also involves responding to quality-related inquiries, overseeing corrective action plans, conducting root cause analyses, and representing the organization in community initiatives and with state-based committees and accreditation authorities. Additionally, the Director oversees performance improvement projects as directed by state regulators, ensures compliance with regulatory reporting, and aids in budgeting, financial forecasting, strategic planning, and workload prioritization.

Requirements

Bachelor of Science in Nursing (BSN) or other degree in a healthcare, business, management or related field is required
Minimum of five (5) years of leadership/management experience is required
Minimum of three (3) years of experience in Medicaid, or a managed care organization is required
Minimum of five (5) years of healthcare quality experience to include developing, implementing and/or evaluating Quality Improvement Programs is required
Experience in data collection, analysis and trending of processes and outcomes
Intermediate computer skills; proficient in Microsoft Word, Excel, and PowerPoint
Demonstrated understanding of complex healthcare industry, health plan and business processes specific to quality and performance Improvement, and quality methodology.
Demonstrated experience in a high-growth business environment.
Strong presentation skills
Ability to work in a demanding environment and quickly reprioritize based on needs.
Effective critical thinking skills with attention to detail
Ability to develop, prioritize and accomplish goals.
Effective communication skills (both written and verbal) and ability to work with multi-disciplinary departments across the organization to achieve goals that are dependent on multiple areas across the enterprise.
Strong people skills and high level of professionalism
Ability to work independently and within a team environment.
Active listening and critical thinking skills
Strategic leadership/management skills
Customer service, member-focused orientation
Certified Professional in HealthCare Quality (CPHQ) by the National Association for Healthcare Quality (NAHQ) within six (6) months of employment is required

Nice To Haves

Masters in Nursing, Business, Management or related field is preferred

Responsibilities

Executes Quality Improvement program for assigned market(s) while ensuring that quality improvement goals, outcomes, and market compliance with NCQA accreditation and quality requirements, as well as state requirements, are met
Develops, organizes, and monitors the Quality Improvement Program, Quality Improvement Plan and QAPI processes annually, and guides their implementation
Annually collaborates with stakeholders, reviews, incorporates recommendations, and communicates the Quality Improvement Program to appropriate stakeholders by defined time limits
Annually evaluates the previous year’s Quality Improvement Program to collaboratively develop the work plan for the upcoming year
Analyze potential member risk data and quality data to improve quality performance and care for members across organizational lines of business
Oversees and/or chairs workgroups and committees, to improve quality measure outcomes in their respective market
Collaborates with business owners across the enterprise to successfully deliver quality related standards in compliance within defined timeframes
Ensures quality requirements are met through continual review, audit and monitoring of quality improvement / performance improvement activities
Responds to administrative inquiries related to quality issues or audits; oversees the development of corrective action plans, as needed
Oversees analysis, including root cause analyses, with support from identified business owners and departments; ensures data is presented and used effectively to address quality and performance improvement identified issues
Participates in community-based initiatives related to QI program initiatives
Establishes and maintains standards and procedures for quality reporting and documentation and communicates areas of strengths as well as opportunities for improvement through the Quality Committees
Externally represents CareSource to appropriate state-based committees, consultants, representatives, and accreditation authorities
Oversees performance improvement projects as directed by state regulators
Ensures compliance with regulatory quality reporting requirements and maintains an in-depth knowledge of the company’s business and regulatory and accreditation environments
Aids in the budgeting and financial forecasting/ analysis process
Assists in strategic planning and prioritizes staff workload
Perform any other job related instructions, as requested