Director, Quality Improvement
About The Position
The Director, Quality Improvement leads and directs process improvement activities to create more efficient and streamlined workflows. The role leads and collaborates on NCQA accreditation and/or HEDIS performance, supports quality improvement for risk adjustment across all products, and partners with the Medicare STARS team to improve ratings, including HEDIS, CAHPS, and HOS. The director oversees provider satisfaction surveys, develops improvement action plans, researches and applies operational best practices, and presents results and ongoing performance measures to senior management. The role also establishes policies, procedures, and goals consistent with internal and external guidelines, and reviews and implements new technology and processes while fostering collaboration with internal and external stakeholders. The position collaborates with State, County, and local agencies, community stakeholders, and communities to promote services that improve health outcomes, reduce health disparities, and lower the cost of care. It oversees health plan cultural competence efforts, including culturally inclusive practices and provider training; assessment of provider-network cultural diversity and resources; provider-practice monitoring through health equity dashboard KPIs; population-specific activities and cultural community support systems; and a comprehensive, outcomes-based Cultural Competency Plan aligned with CLAS standards and national and regional priorities. The role also manages the outreach budget for Cultural Competency programs and sponsorships. Must reside in Indiana or be willing to relocate to Indiana. Performs other duties as assigned and complies with all policies and standards.
Requirements
- Bachelor’s degree in nursing, another related field, or equivalent experience.
- At least 7 years of quality management, quality improvement, or healthcare operations experience.
- Must reside in Indiana or be willing to relocate to Indiana.
Nice To Haves
- Master’s degree.
- Current state RN license.
- Certified Professional in Health Care Quality certification.
- Formal certification in quality improvement, risk management, or a parallel field may be required in certain states.
Responsibilities
- Lead and direct process improvement activities to create more efficient and streamlined workflows.
- Lead and collaborate on NCQA accreditation and/or HEDIS performance.
- Oversee quality improvement aspects of risk adjustment processes for all products.
- Collaborate with the Medicare STARS team to improve Medicare product ratings, including HEDIS, CAHPS, and HOS.
- Oversee provider satisfaction surveys and implement improvement action plans.
- 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 foster teamwork with internal and external constituencies.
- Present improvement results and ongoing performance measures to senior management.
- Formulate and establish policies, operating procedures, and goals in compliance with internal and external guidelines.
- Collaborate with State, County, and local agencies to promote services that improve health outcomes, decrease health disparities, and reduce the cost of care.
- Work with agencies, community stakeholders, and communities to monitor the application of standards.
- Promote cultural competence throughout the health plan by implementing culturally inclusive practices and innovations, including provider trainings.
- Oversee assessment of provider-network cultural diversity, resources, and gaps, including needs analysis for non-traditional providers, and develop recommendations for credentialing and network development.
- Monitor and evaluate provider practices through health equity dashboard KPIs to assess and improve cultural competence, address care gaps, and align interventions.
- Oversee population-specific activities, including training, media awareness, partnerships with external equity stakeholders, cultural treatment teams, and cultural community support systems.
- Oversee a comprehensive, outcomes-based Cultural Competency Plan aligned with CLAS standards and national and regional priorities, incorporating data-driven assessments and a strategy for ongoing monitoring and improvement.
- Manage the outreach budget for Cultural Competency programs and sponsorships.
- Perform other duties as assigned and comply with all policies and standards.
Benefits
- Health insurance
- 401(k)
- Stock purchase plans
- Tuition reimbursement
- Paid time off and holidays
- Flexible work arrangements, including remote, hybrid, field, or office schedules
- Competitive pay
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What This Job Offers
Job Type
Full-time
Career Level
Director
