VP Medicare Stars Quality Mgmt

VP Medicare Stars & Quality Mgmt.

Summary of Position:

Responsible for our Quality performance and results across all lines of business (Medicare Stars Medicaid QIA HARP Withhold Program Essential Plan QIA NCQA Ratings). Provide leadership over projects designed to drive quality performance reduce administrative and medical costs; improve
core process efficiency effectiveness and responsiveness; measure and improve business critical operational KPIs/metrics especially in the areas of customer satisfaction/loyalty/retention. Lead the development of enterprisewide quality improvement strategies including developing programs and initiatives to improve the quality of care and services provided to members across all product lines. Support the Enterprisewide Health disparity & Social Determinants of Health (SDOH) strategy initiatives and reporting efforts. Oversee enterprisewide NCQA accreditation and CMS and NY statespecific quality regulatory requirements ensuring adherence to accreditation standards and requirements. Responsible for our Quality Program (Risk Management Review Operations Improvement & Health Promotion Measurement Delegation Oversight and Accreditation). Oversee provider quality collaborative and key provider Value Based Payment (VBP) programs including the design and reporting of the Provider P4P program and Quality sections of all VBP contracts. Develop Annual QI Program Evaluation and Work Plan across the enterprise for various LOBs for approval by the QIC andQuality Committees of the Board. Provide day to day leadership and direction to all direct reports utilizing the enterprises core values. Ensure corporate departmental and budgetary goals are met by continuous evaluation development of process improvement activities and adaptation of best practices. Responsible for our Quality Program (Risk Management Review Operations Improvement & Health Promotion Measurement Delegation Oversight and Accreditation).

Principal Accountabilities:

• Make significant contributions towards short and longterm business initiatives which include Operating Income Administrative Expenses Medicare Medicaid HARP Essential Plan NCQA ratings and CAHPS performance.
• Identify hire & train staff members developing them into strong leaders and creating highperforming selfdirected teams.
• Effectively plan for succession planning ensuring talent pipeline.
• Act as change agent to drive and effect organizational change ensuring key deliverables are met.
• Establish datadriven quality initiatives collaborating with multidisciplinary teams monitoring compliance with healthcare regulations and championing patient advocacy. Ensure that the functional vision and implementation plans align with the core strategic vision and business objectives.
• Oversee the implementation of a strategic vision for healthcare quality ensuring adherence to rigorous regulatory standards and fostering a culture of continuous improvement. Perform strategic decisionmaking leadership planning and prioritization to meet business and quality/compliance objectives.
• Evaluate the quality of patient care and safety. Accountable for understanding coordinating and measuring performance of internal and external quality and safety requirements. Document improvement action plans for processes and projects assigning the responsibilities to the various teams. Carry out Root Cause Analysis of errors to prepare action plans; coordinate with various internal teams to drive actions.
• Create and communicate a vision for quality within the company setting goals and recommending organizational changes to achieve these goals. Carry out project review meetings to ascertain progress.
• Create an environment conducive to continuous quality improvement and implement systems to nurture quality excellence.
• Direct activities of companywide quality staff and departmental activities to ensure product quality through test procedures and processes.

Education Training Licenses Certifications:

• Bachelors required; masters degree preferred
• 12 15 years of managed care experience
• Strong background in clinical financial technical and operations management and demonstrated proficiency in business management similar in scope
• Strong knowledge of the clinical practice of medicine health care delivery systems utilization methods
• Strong knowledge and understanding of managed care principles and industry evolution

Relevant Work Experience Knowledge Skills and Abilities:

• Strong Analytical skills to collect and analyze information problemsolve and make decisions
• Proven ability to interpret and present information to enable senior management and business stakeholders to make sound decisions
• Demonstrated success in creating and maintaining a culture of quality in a large global organization
• Knowledge and experience in performing internal and external quality audits
• Knowledgeable and experienced in planning coordinating and leading QMS management reviews
• Root cause / corrective action expertise
• Detailoriented analytical and able to manage multiple tasks in a fastpaced environment
• Welldeveloped written and verbal communication skills
• Positive teamfocused approach and proven leadership track record including people development and project management

We are anequalopportunityemployer and prohibit discrimination/harassment without regard to race color religion age sex national origin disability status genetics protected veteran status sexual orientation gender identity or expression or any other characteristic protected by federal state or local laws