Director, Quality Improvement

Medica • Minnetonka, MN

255d • $111,200 - $190,600

About The Position

The incumbent is responsible for setting the strategy and assuring implementation of the plan for clinical programs focused on data collection, analysis and leading improvement initiatives for HEDIS, star ratings, retrospective risk adjustment and education, and government audits requiring medical record review. The Director interfaces with all departments within Medica, external vendors and providers, state and federal regulators, advocacy groups and members. The incumbent sets the strategy and direct improvement initiatives to meet program goals that yield measurable outcomes.

Requirements

• Bachelor's degree or equivalent experience in related field
• 10 years of related work experience beyond degree
• 5-8 years of leadership experience preferred
• Experience with financial modeling in a healthcare context
• Demonstrated knowledge of project management principles, methodologies, and best practices
• Familiarity with Medicare Advantage reimbursement structures
• Working knowledge of Medicare guidance review and interpretation
• Understanding of technical specifications behind CAHPS, HOS, Stars, NCQA, and HEDIS measures
• Demonstrated understanding of quality theory, data collection, analysis and study design; ability to track and display data; ability to design, implement and evaluate interventions
• Proven track record of developing and implementing quality strategy and new programs to include innovative value based methodologies
• Demonstrated ability to analyze metrics, summarizes key business learning, and translate into tactical plans
• Demonstrated ability to lead, influence change, initiate and shape work with colleagues inside and outside the organization to achieve goals
• Proven ability to communicate effectively with all levels within the organization
• Direct experience meeting Regulatory/Medicare requirements
• Excellent strategic thinking and analytical skills
• Ability to understand and use data to facilitate decision making
• Critical thinking skills to understand cause and effect relationships and conduct root cause analysis
• Proficiency in developing communication strategies for a wide array of audiences that support strategic objectives
• Demonstrated leadership with teams and peers
• Ability to build effective collaborative partnerships, build alliances and gain consensus to drive results

Nice To Haves

• CPHQ or Lean Certified

Responsibilities

• Development & Execution of Quality measurement & improvement program strategy
• Sets the strategy and directs the development and execution of quality measurement and improvement programs in support of market segments and regulatory and accreditation requirements that are performance-based, measurable and results-oriented
• Sets the strategy and directs development and execution of member and provider education designed to effectively improve Medica's quality program results
• Directs star program level communications with CMS
• Provides subject matter expertise on Star & HEDIS measures and improvement efforts across Medica, including financial and regulatory impacts
• Collaborates with all departments at Medica to collectively improve performance on quality measures
• Directs development and execution of product specific action plans for improvement of quality measures
• Execution of governmental audits
• Oversees the execution of government audits requiring medical record reviews including plan development, execution and communication to stakeholders
• Assures the highest quality audits are conducted and required timelines are met
• Oversees management of annual budget for the Quality Measurement & Improvement area
• Provides analysis, justification and management of investments in support of dynamic and changing regulatory and accreditation requirements around quality programs
• Champions investments and prioritization of Quality Improvement intervention strategy to ensure the highest possible quality program results
• Builds and shapes a highly-effective Quality organization by hiring, training, motivating and setting leadership direction for direct reports and key cross-functional team members that support Medica's quality strategy
• Manages day-to-day team responsibilities and workload while anticipating future operating model needs, maximizing team resources and skill sets
• Works with staff members to develop annual goals, measure progress against the goals and perform the annual performance review process to support overall segment objectives
• Defines and nurtures a collaborative and customer-oriented culture among direct team and cross-functional relationships
• Acts as a mentor to others

Benefits

• Competitive medical, dental, vision
• PTO
• Holidays
• Paid volunteer time off
• 401K contributions
• Caregiver services
• Generous total rewards package

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Industry: Professional, Scientific, and Technical Services
• Education Level: Bachelor's degree