Director - Performance Improvement
About The Position
Prominence Health is a value-based care organization bridging the gap between affiliated health systems and independent providers, building trust and collaboration between the two. Prominence Health creates value for populations and providers to strengthen integrated partnership, advance market opportunities, and improve outcomes for our patients and members. Founded in 1993, Prominence Health started as a health maintenance organization (HMO) and was acquired by a subsidiary of Universal Health Services, Inc. (UHS) in 2014. Prominence Health serves members, physicians, and health systems across Medicare, Medicare Advantage, Accountable Care Organizations, and commercial payer partnerships. Prominence Health is committed to transforming healthcare delivery by improving health outcomes while controlling costs and enhancing the patient experience. Job Summary: The Director of Performance Improvement will take responsibility and ownership of the Quality Improvement Program and will provide leadership, implementation and oversight of the comprehensive duties such as managing the Star Rating Program, HEDIS, CAHPS, HOS, and other quality initiatives. Additionally, the Director of Performance Improvement will have primary responsibility for interfacing strategic operations with the Provider Relations team; this included the design, collaboration, and execution of all performance improvement programs that depend on provider participation. The Director will integrate programs with coding and documentation initiatives wherever possible. The Director will collaborate with the Manager of Quality Improvement to ensure that the quality improvement plan supports regulatory and accreditation goals. The Director will have direct oversight of the HEDIS Program Manager and ensure that the HEDIS strategy supports the attainment of Star Rating and accreditation goals. The Director will implement and operationalize a variety of quality improvement initiatives that impact overall quality ratings for the plan. About Universal Health Services: One of the nation’s largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (UHS) has built an impressive record of achievement and performance. During the year, UHS was again recognized as one of the World’s Most Admired Companies by Fortune; and listed in Forbes ranking of America’s Largest Public Companies. Operating acute care hospitals, behavioral health facilities, outpatient facilities and ambulatory care access points, an insurance offering, a physician network and various related services located all over the U.S. States, Washington, D.C., Puerto Rico and the United Kingdom.
Requirements
- Bachelor Degree or higher.
- Minimum 7 years’ experience in a managed care, and quality improvement in a health insurance industry
- Expertise in the following subject matters: STARS, HEDIS, CAHPS, NCQA and other quality measures and ratings.
- Experience in the HEDIS reporting requirements
- Supervisory/managerial experience.
- Ability to understand, present and analyze data.
- Proficiency with computer operations, including spreadsheet and database application.
Nice To Haves
- Training/certification in formal process improvement methodologies preferred (i.e. Lean, Six Sigma, etc.)
- Healthcare project management experience preferred
- Working knowledge of Medicare and/or Commercial risk adjustment programs preferred.
- Experience with improving Plan Star ratings.
Responsibilities
- Managing the Star Rating Program, HEDIS, CAHPS, HOS, and other quality initiatives.
- Interfacing strategic operations with the Provider Relations team.
- Design, collaboration, and execution of all performance improvement programs that depend on provider participation.
- Integrating programs with coding and documentation initiatives wherever possible.
- Collaborating with the Manager of Quality Improvement to ensure that the quality improvement plan supports regulatory and accreditation goals.
- Direct oversight of the HEDIS Program Manager and ensuring that the HEDIS strategy supports the attainment of Star Rating and accreditation goals.
- Implementing and operationalizing a variety of quality improvement initiatives that impact overall quality ratings for the plan.
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What This Job Offers
Job Type
Full-time
Career Level
Director
