Director, Quality Improvement, Digital Quality Measurement
About The Position
Lead and direct process improvement activities that provide more efficient and streamlined workflow. This leadership role will shape and execute the organization’s digital quality measurement strategy, helping modernize how clinical quality data is collected, validated, and reported. Applicants for this job have the flexibility to work remote from home anywhere in the United States. Experience with digital quality measurement, HEDIS, ECDS, FHIR, healthcare interoperability, or related quality transformation initiatives highly preferred. The ideal candidate will combine strategic thinking with knowledge of audit readiness and the ability to translate clinical requirements into operational and technology solutions.
Requirements
- Bachelor's Degree Nursing, other related field or equivalent experience required.
- 7+ years of quality management, quality improvement or healthcare operations experience required
- Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J-1, OPT, or CPT.
Nice To Haves
- Master's Degree preferred.
- Experience with digital quality measurement, HEDIS, ECDS, FHIR, healthcare interoperability, or related quality transformation initiatives highly preferred.
- Certain states may require a formal certification in quality improvement, risk management, or another parallel field
- Current state’s RN license preferred
- Certified Professional in Health Care Quality preferred
Responsibilities
- Responsible for leading and collaborating with others on National Committee for Quality Assurance (NCQA) Accreditation and/or Healthcare Effectiveness Data and Information Set (HEDIS) performance
- Responsible for quality improvement aspects of risk adjustment processes for all products
- Collaborate with Medicare STARS team to improve overall STARS ratings for Medicare products (including HEDIS, CAHPS, HOS)
- Oversee provider satisfaction surveys and implement action plans for improvements
- Research and incorporate best practices into operations
- Organize and control activities, methods, and procedures to achieve business objectives
- Review and implement new technological tools and processes and fosters team concept with internal and external constituencies
- Present results of improvement efforts and ongoing performance measures to senior management
- Formulate and establish policies, operating procedures, and goals in compliance with internal and external guidelines
- Lead the strategy, roadmap, testing, validation, and audit readiness for digital quality measurement, HEDIS, and related clinical quality initiatives
Benefits
- competitive pay
- health insurance
- 401K
- stock purchase plans
- tuition reimbursement
- paid time off plus holidays
- a flexible approach to work with remote, hybrid, field or office work schedules
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What This Job Offers
Job Type
Full-time
Career Level
Director
