Grow and lead among an award-winning and extraordinary organization that's dedicated to providing premier service and delighting members, 24/7/365. It all begins with how we care about the people we serve. Since 2015, our mission has guided our principles towards delivering solutions for a rapidly changing industry. Compassionate Care is at the center of all we do, and it unites us to foster an environment where everyone is empowered, inspired, and equipped for success.

We make a difference in the lives of millions; that’s something we can be proud of.

Compensation for all positions is competitively higher than the current marketplace. Simply put - we pay more. We also offer a competitive benefits program, designed to support employees and their families across all dimensions of health including medical, dental, vision, life, disability, 401(k) and paid holidays/time off for eligible employees. You can earn even more through referral bonuses. Achieve your potential and grow your career at NationsBenefits.com/Careers.

Job Role:

The Director, Intervention Operations provides strategic direction, leadership, and oversight for Outcomes and Interventions programs at Nations Benefits. This role will assume end-to-end ownership of operationalizing and scaling outcome intervention components for each product line. Also, this role is responsible for oversight of planning, organizing, and directing the administration of Outcome Programs/Strategies to maximize member engagement of Nations Benefits products, increase outcomes including Medicare Stars measures and similar quality rating systems. The Director will be expected to grow the value of the Outcome program portfolio to ensure quality delivery while exceeding client service levels agreements. Provides leadership to and is accountable for the performance and direction through multiple layers of management and senior-level professional staff. Responsible for coordinating with appropriate personnel to meet operational program needs and ensuring compliance with state/federal health plan requirements, Medicare guidelines, NCQA, and health plan requirements. Provides long-term planning and oversight to ensure activities are appropriately integrated into strategic direction and operations, as well as the mission and values of the company.

Duties & Responsibilities includes:

• Provides leadership and support in establishing and directing the outcome Programs for specific Clients, contracts, and measure sets.
• Responsible for development and oversight of Quality Improvement (QI) Projects, campaigns and Performance Improvement activities related to HEDIS and STARS
• Ensures compliance with External Quality Review audits/studies, Performance Improvement Projects, and Quality Improvement Projects required by the client
• Responsible for the review of QI issues regarding compliance with Federal, State, and Accreditation requirements for the client
• Provide functional and technical knowledge for NCQA/HEDIS/ STARS across all departmental staff and deliver educational sessions to internal staff and external constituents as needed.
• Collaborate with key business leaders on the roadmap for current and future benefit product portfolio
• Promotes understanding, communication, and coordination of all quality improvement program components and provider quality tools
• Serves as a Medicare Stars and HEDIS quality expert on performance measures and strategies to improve
• Maintains Star program documents, reports, and committee minutes and follows all internal privacy and confidentiality policies and procedures
• Leads the coordination and completion of projects with cross-functional teams and senior leaders across medical/nursing/clinical functional areas to achieve targeted clinical strategic performance goals
• Respond to questions that pertain to STARS and Quality Improvement from client and internal staff members
• Foster relationships with all internal departments and internal/external key stakeholders to ensure flawless execution of plans
• Implement opportunities for process improvement that impact quality measurements in assigned product and client
• Leads Quality Monitoring in identifying and evaluating the markets risk areas related to Federal, State and Accreditation requirements and monitor performance against the requirements
• Monitor industry trends as it relates to healthcare and identify areas of opportunity for improvements
• Perform any other job-related instructions, as requested

Skills and Qualifications:

• Bachelor’s or master’s degree or equivalent years of relevant work experience is required
• A minimum of Ten (10) years of experience in a healthcare or managed care organization is required
• Experience in Medicare Advantage, STARS, Quality Programs and HEDIS
• 5+ years of project management experience

Preferred Qualifications:

• Full understanding of NCQA accreditation and standards
• Previous claims systems experience
• Full understanding of STARS and HEDIS measures
• Managed care experience preferred
• Proficiency in all Microsoft Office Suite, especially Microsoft Excel

NationsBenefits is an Equal Opportunity Employer.