Responsible for driving the development, coordination, communication, and implementation of a strategic clinical quality management and improvement program within assigned health plan
Work with the regional head of quality management to direct clinical quality initiatives such as HEDIS and CAHPS quality improvement
Maintain expert knowledge of current industry standards and quality improvement activities
Serve as a resource for the design and evaluation of process improvement plans
Collaborate with leaders in developing, monitoring, and evaluating Healthcare Effectiveness Data Information Set (HEDIS) improvement action plans
Monitor and report quality measures per state, Centers for Medicare and Medicaid Services (CMS), and accrediting requirements

Requires BA/BS in a clinical or health care field (i.e. nursing, epidemiology, health sciences)
Minimum 5 years progressively responsible experience in a health care environment
Strong BH quality management experience preferred
Certified Professional in Healthcare Quality (CPHQ) or HCQM certification preferred
Demonstrated expertise with NCQA accreditation strongly preferred
Extensive experience leading large-scale, cross-functional initiatives involving data integration, reporting infrastructure, and partnership with IT and analytics teams preferred
Proven ability to lead in a highly matrixed environments
Experience managing state-regulated contracts with high reporting volume preferred
Deep familiarity with clinical workflows, member safety events, and behavioral health care delivery models preferred

Medicaid Quality Management Director

Key skills