VP, National Quality Data Management & Performance

Molina Healthcare•Long Beach, CA

About The Position

Provides executive level strategy and leadership for team responsible for Molina enterprise quality data management and performance activities. Responsible for establishing data strategy, design, policies, execution and performance. Oversees design and development of reporting solutions to support Healthcare Effectiveness Data and Information Set (HEDIS) auditing, rate tracking, identification of targeted interventions, and performance metric outcome tracking, and the collection, validation, analyzation, and organization of data into meaningful reports for operational/strategic analysis and decision-making. Collaborates with senior health plan, segment, and functional leaders across the enterprise to align and prioritize business objectives and initiatives related to quality data management and performance.

Requirements

At least 12 years of progressive experience in quality data management, HEDIS operations and performance outcomes management, including at least 8 years of managed care experience, or equivalent combination of relevant education and experience.
At least 7 years management/leadership experience.
Previous experience leading multiple markets and/or product lines.
Experience developing and managing department budget within prescribed parameters.
Ability to influence and drive change across internal/external stakeholders.
Skill to envision, craft proposals, obtain consensus around approving and implementing future state processes and systems needed to support strategic direction set by organization.
Strong business acumen with the ability to connect data insights to strategic goals.
Ability to communicate complex analytical/performance results clearly to non-technical audiences and senior leaders.
Proven ability to lead cross-functional projects and deliver value added results in a matrixed environment.
History of executing change management and building credibility with key stakeholders to drive organizational change.
Strong data analysis, problem-solving, and critical-thinking skills.
Skilled in planning and delivering critical/complex projects.
Strong executive presence and strategic leadership abilities.
Excellent verbal/written communication skills, and presentation skills.
Microsoft Office suite and applicable software programs proficiency.

Nice To Haves

Deep experience in quality data strategy, design, execution and performance.
Strong health care industry expertise with extensive knowledge of industry best practices related to quality.
Experience in a quality leadership role with a managed care payer with experience in all lines of business (Medicaid, Medicare, and/or Marketplace).

Responsibilities

Provides strategy development, vision and direction for quality data management, reporting and performance across the Molina enterprise.
Demonstrates accountability for performance and financial results, and keeps executive leadership apprised.
Manages and leads high-performing, cross-functional teams in large-scale quality data management and performance initiatives; drives a culture of continuous improvement to ensure timely delivery of all commitments.
Oversees development of standardized reporting including dashboard summaries to appropriately identify impactable opportunities, projected performance including financial impacts for revenue at risk, auto-assignment, sanctions, penalties, Medicare Stars rating system (Stars) and plan ratings.
Establishes mechanisms for measurement of performance outcomes including impacts to revenue for all revenue optimization activities.
Ensures compliance with all current regulatory requirements related to quality data management and performance.
Supports new plan implementations and integrations related to quality data management and performance.
Collaborates with health plan/quality leaders to support overall health plan quality/data management/reporting and financial performance.
Responsible for development of a clinical data acquisition strategy through internal and external partnerships, including vendor management, for purposes of supporting quality performance and risk adjustment.
Supports end-to-end quality data management; collaborates with information technology (IT) and other technical teams to drive quality improvement/quality performance management.
Responsible for end-to-end HEDIS data management reporting and validation to support health plan Healthcare Effectiveness Data and Information Set (HEDIS)/Medicare Star ratings system (Stars)/state reporting, and Consumer Assessment of Healthcare Providers and Systems (CAHPS).
Responsible for the operational audits for HEDIS, CAHPS and supplemental data processes.
Ensures successful and optimized HEDIS projects and submissions across all lines of business (LOBs).
Manages successful regulatory relationships including relationships with HEDIS auditors and the National Committee for Quality Assurance (NCQA).
Oversees quality/risk adjustment budget management, and supports analysis of financial impacts to budget related to quality.
Sets and manages overall costs to meet/exceed annual budgets and identifies ways to improve productivity and automation wherever possible to reduce unit costs and overall general and administrative expense (G&A) for the organization.
Reports potential risks and liabilities related to quality performance to senior leadership.
Hires, trains, develops and manages team; demonstrates accountability for team performance and achievement of quality/department-specific goals.
Develops and sustains a high-performance team, dedicated to best in class solutions; responsible for attracting, developing and retaining top-tier talent to support strategy and long-term business objectives.