Director, Quality Improvement

HCSC•Chicago, IL

9d•Hybrid

About The Position

At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers. Join HCSC and be part of a purpose-driven company that will invest in your professional development. Job Summary This position is responsible for managing and directing clinical quality improvement and population health oversight activities, driving continuous quality improvement consistent with HCSC goals, regulatory requirements, and accreditation. The senior director will remain current with best practices and innovations in the areas of quality improvement, population health and clinical quality measurement, and provide guidance and support to local quality teams, FEP, and HCM stakeholders. Fundamental to the role is a mastery of healthcare quality improvement methodologies and the measurement of healthcare processes and structures that contribute to primary and intermediary health outcomes. Working knowledge of NCQA, URAC, HEDIS, STARS, FEP, medical policy issues, condition management, social determinants of health/health equity, health informatics, quality improvement best practices and innovative strategies to improve the quality of care and member experience. J ob Responsibilities: 1) Oversee a team responsible for evaluating and developing quality improvement and population health programs and initiatives that lead to improvements in clinical quality outcomes, with attention to care disparities and social determinants of health. 2) Work with the Enterprise Quality Reporting (EQR) team to identify line of business and regional variations in clinical quality measures and population health statistics to inform targeted solutions. 3) Collaborate with EQR to design, deliver and communicate reporting tools to support quality improvement and accreditation efforts. 4) Work with the quality, data science and analytics teams to measure the impact of existing quality programs, design and communicate initiatives that effectively target variations in healthcare measures. 5) Collaborate with Quality Operations team to coordinate quality improvement outreach efforts and initiatives and that support Accreditation Governance strategy. 6) Partner with EQ&A and Quality Improvement Committee Meetings around quality best practices. 7) Develop, review and sign off on relevant policies and procedures 8) Maintain regular communication with management regarding developments within areas of assigned responsibilities and perform special projects as required or requested. 9) Maintain currency with HEDIS, Hospital and other quality data sets, accreditation standards and a knowledge of market place, products, health care initiatives, technology, etc. 10) Comply with HIPAA, Diversity Principles, Corporate Integrity, Compliance Program policies and other applicable corporate and departmental policies. 11) Support and/or provide cross coverage in support of additional functions to ensure seamless execution of divisional priorities. 12) Maintain complete confidentiality of company business. 13) Overseeing the annual budget and allocating resources for various projects and operational needs. 14) Translating needs and initiatives into compelling business cases. 15) Conducting cost-benefit analyses to justify investments and ensure ROI. 16) Other duties as assigned.

Requirements

Bachelor’s Degree with 10 years’ experience in a healthcare insurance or provider setting in a quality improvement function or oversight role
5 years leadership/management experience
Proven track record in developing innovative quality improvement strategies
Strong analytical, presentation & clear, concise verbal / written communication skills
Ability to adapt complex concepts to a range of audiences & express complex relationships in simple visual terms
Executive presence with the ability to influence inside and outside HCSC
Business and financial acumen; experience with operating, budgeting and financial forecasting
Experience leading, formulating and delivering strategy; building strong connections with people and team
Ability to work effectively within a matrixed organization with multidisciplinary teams, across multiple geographic areas, with attitude toward team building.
Able to meet deadlines under pressure.
Willing and able to travel out of state

Nice To Haves

RN or post-graduate education in Health Care Administration or a health-related field, public health and/or MBA.
Quality experience and Medical Management experience in a leading managed care/insurance or provider organization.
Health Informatics Training
Familiarity with clinical coding and statistical and reporting software
Knowledge of health care reimbursement models.
Experience in provider and vendor negotiations and contracting models, provider relation and member services.
Familiarity with Government Programs, Stars ratings and Retail products

Responsibilities

Oversee a team responsible for evaluating and developing quality improvement and population health programs and initiatives that lead to improvements in clinical quality outcomes, with attention to care disparities and social determinants of health.
Work with the Enterprise Quality Reporting (EQR) team to identify line of business and regional variations in clinical quality measures and population health statistics to inform targeted solutions.
Collaborate with EQR to design, deliver and communicate reporting tools to support quality improvement and accreditation efforts.
Work with the quality, data science and analytics teams to measure the impact of existing quality programs, design and communicate initiatives that effectively target variations in healthcare measures.
Collaborate with Quality Operations team to coordinate quality improvement outreach efforts and initiatives and that support Accreditation Governance strategy.
Partner with EQ&A and Quality Improvement Committee Meetings around quality best practices.
Develop, review and sign off on relevant policies and procedures
Maintain regular communication with management regarding developments within areas of assigned responsibilities and perform special projects as required or requested.
Maintain currency with HEDIS, Hospital and other quality data sets, accreditation standards and a knowledge of market place, products, health care initiatives, technology, etc.
Comply with HIPAA, Diversity Principles, Corporate Integrity, Compliance Program policies and other applicable corporate and departmental policies.
Support and/or provide cross coverage in support of additional functions to ensure seamless execution of divisional priorities.
Maintain complete confidentiality of company business.
Overseeing the annual budget and allocating resources for various projects and operational needs.
Translating needs and initiatives into compelling business cases.
Conducting cost-benefit analyses to justify investments and ensure ROI.
Other duties as assigned.