PHP Director Quality Management
General Purpose of Job:
This position is responsible for the overall leadership and direction of the Quality Management Department. This includes the design, development, and implementation of strategies to support the profitable operation of the Plan, as well as directing Plan activities necessary for meeting quality-related regulatory requirements and maintaining accreditation. Has an integral role in the development of new products, including, but not limited to Medicare Advantage. Leads the Quality Department components of accurate capture and validation of risk. Works with Plan leadership to assess opportunities for improvement and to implement changes designed to have a positive impact on outcomes, cost, and membership growth. Also works with Health System leadership, both internal and external, to align strategies and maximize outcomes.
Essential DutiesDirect Quality Department operations, maximizing efficiencies and assuring a high level of productivity of clinical and non-clinical staff.
This job description is intended to cover the minimum essential duties assigned on a regular basis. Associates may be asked to perform additional duties as assigned by their leader. Leadership has the right to alter or modify the duties of the position.
Develop and implement plans to ensure the success of new products (Medicare Advantage, etc).
Ensure compliance with all Quality-related requirements for populations with government sponsored coverage (Medicare Advantage, Marketplace, Medicaid).
Collaborate with other Plan departments to develop and implement effective plans to accurately capture and validate risk.
Work within Sparrow Health System and other partner Health Systems to develop and implement outcome-driven quality initiatives.
Produce quality outcomes to maximize plan STAR rating with CMS for Medicare Advantage and Marketplace products.
Direct Plan activities related to accreditation and regulatory compliance.
Lead the creation of the annual QI/MRM Program Descriptions, Work Plans and Program Evaluation.
Develop and manage agendas and activities of the Quality Committee of the Board and the Quality Improvement/Medical Resource Management Committee.
Direct the development and revision of the Quality Department policies and procedures.
Direct successful annual HEDIS reporting project; design and implement programs to increase health outcomes, use of recommended services, and member satisfaction.
Represent Plan at key state-wide committees and workgroups.
Contribute to Plan membership growth through the development of relationships with purchaser groups.
Take an active role in the bid and renewal process by producing and presenting quality outcomes to various internal and external stakeholders.
Lead in the design, implementation, and marketing of new quality programs and services.
Perform operational analyses to determine strengths and weaknesses from outcomes; design and implement programs to improve outcomes.
Remain knowledgeable about benchmark plan best practices. Educate other operational areas about programs to improve quality outcomes.
Improve member health and through use of technology and tools.
Work with technology vendors to identify and implement tools to support Quality operations and goals.
Develop meaningful department metrics and reporting.
Lead team members in efforts to ensure Complete and Correct Coding for audits and accurate risk capture.
General RequirementsCurrent unrestricted clinical license
Work ExperienceMinimum of 3 years of experience with personnel management, staff development, problem solving and strategic planning
Previous experience in senior management related to healthcare delivery, preferably with a health plan (Preferred)
EducationBS/BA Degree in Nursing, Health Care Administration or related field.
Masters degree in Business or relevant field
Specialized Knowledge and SkillsCapable of managing a variety of complex issues while driving momentum of key projects.
Expert negotiation skills, as well as excellent communication skills, both verbal and written.
Ability to handle difficult situations diplomatically.
Effective interpersonal influence, collaboration and listening skills.
Strong leadership skills with demonstrated ability to evaluate, plan and implement actions to produce measurable outcomes.
Excellent team builder with an ability to build consensus among diverse groups.
Capable of working collaboratively in partnership with health plan and health system leadership.
Demonstrated performance as a change agent with skills to effectively and productively implement significant change in a fast-paced environment.
Sparrow Health System is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected Veteran status.
How to apply:
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Lansing, MI 48901