Director Market Quality Improvement(Ohio Residency Required)

Job Summary:

The Director, Market Quality Improvement is responsible for directing activities to achieve defined quality goals and outcomes and improve quality performance for assigned market(s).

Essential Functions:

• Executes Quality Improvement program for assigned market(s) while ensuring that quality improvement goals, outcomes, and market compliance with NCQA accreditation and quality requirements, as well as state requirements, are met
• Develops, organizes, and monitors the Quality Improvement Program, Quality Improvement Plan and QAPI processes annually, and guides their implementation
• Annually collaborates with stakeholders, reviews, incorporates recommendations, and communicates the Quality Improvement Programto appropriate stakeholders by defined time limits
• Annually evaluates the previous year’s Quality Improvement Program to collaboratively develop the work plan for the upcoming year
• Analyze potential member risk data and quality data to improve quality performance and care for members across organizational lines of business
• Oversees and/or chairs workgroups and committees, to improve quality measure outcomes in their respective market
• Collaborates with business owners across the enterprise to successfully deliver quality related standards in compliance within defined timeframes
• Ensures quality requirements are met through continual review, audit and monitoring of quality improvement / performance improvement activities
• Responds to administrative inquiries related to quality issues or audits; oversees the development of corrective action plans, as needed
• Oversees analysis, including root cause analyses, with support from identified business owners and departments; ensures data is presented and used effectively to address quality and performance improvement identified issues
• Participates in community-based initiatives related to QI program initiatives
• Establishes and maintains standards and procedures for quality reporting and documentation and communicates areas of strengths as well as opportunities for improvement through the Quality Committees
• Externally represents CareSource to appropriate state-based committees, consultants, representatives, and accreditation authorities
• Oversees performance improvement projects as directed by state regulators
• Ensures compliance with regulatory quality reporting requirements and maintains an in-depth knowledge of the company’s business and regulatory and accreditation environments
• Aids in the budgeting and financial forecasting/ analysis process
• Assists in strategic planning and prioritizes staff workload
• Perform any other job related instructions, as requested

Education and Experience:

• Bachelor of Science in Nursing (BSN) or other degree in a healthcare, business, management or related field is required
• Masters in Nursing, Business, Management or related field is preferred
• Minimum of five (5) years of leadership/management experience is required
• Minimum of three (3) years of experience in Medicaid, or a managed care organization is required
• Minimum of five (5) years of healthcare quality experience to include developing, implementing and/or evaluating Quality Improvement Programs is required

Competencies, Knowledge and Skills:

• Experience in data collection, analysis and trending of processes and outcomes
• Intermediate computer skills; proficient in Microsoft Word, Excel, and PowerPoint
• Demonstrated understanding of complex healthcare industry, health plan and business processes specific to quality and performance Improvement, and quality methodology.
• Demonstrated experience in a high-growth business environment.
• Strong presentation skills
• Ability to work in a demanding environment and quickly reprioritize based on needs.
• Effective critical thinking skills with attention to detail
• Ability to develop, prioritize and accomplish goals.
• Effective communication skills (both written and verbal) and ability to work with multi-disciplinary departments across the organization to achieve goals that are dependent on multiple areas across the enterprise.
• Strong people skills and high level of professionalism
• Ability to work independently and within a team environment.
• Active listening and critical thinking skills
• Strategic leadership/management skills
• Customer service, member-focused orientation

Licensure and Certification:

• Certified Professional in HealthCare Quality (CPHQ) by the National Association for Healthcare Quality (NAHQ) within six (6) months of employment is required

Working Conditions:

• General office environment; may be required to sit or stand for extended periods of time

Compensation Range:

CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type (hourly/salary):

Organization Level Competencies

• Fostering a Collaborative Workplace Culture

• Cultivate Partnerships

• Develop Self and Others

• Drive Execution

• Influence Others

• Pursue Personal Excellence

• Understand the Business