Vice President, Quality Improvement

Role Overview

• Oversee all related activities for the Quality Improvement functions
• Lead and direct process improvement activities for more efficient and streamlined workflow
• Oversee the business processes related to risk adjustment and quality improvement for assigned products and plans
• Responsible for all activities related to NCQA Accreditation and/or HEDIS performance ensuring highest level of accreditation
• Manage all aspects of HEDIS improvement activities, including outreach, incentives, data integrity and chart review
• Review and implement new technological tools and processes and foster team concept with internal and external constituencies
• Present results of improvement efforts and ongoing performance measures and recommend actions plans to senior management
• Research and incorporate quality improvement best practices into operations
• Organize and control activities, methods, and procedures to achieve business objectives
• Formulate and establish policies, operating procedures, and goals in compliance with internal and external guidelines
• Manage and ensure compliance of EPSDT program as well as compliance and turnaround time of grievances and appeals

Requirements

• Bachelor's Degree in Nursing or related clinical field or equivalent experience required, Master's Degree preferred
• 10+ years of healthcare operations experience, including quality improvement and NCQA accreditation experience required
• Experience managing acquisition and integration of external data sources
• Previous management experience including responsibilities for hiring, training, assigning work and managing performance of staff
• Familiarity with running Risk Adjustment prospective and retrospective programs preferred

Benefits

• competitive pay
• health insurance
• 401K and stock purchase plans
• tuition reimbursement
• paid time off plus holidays
• flexible approach to work with remote, hybrid, field or office work schedules