The Quality Director has responsibility for quality programs across all lines of business including commercial and government segments within Dean Health Plan, part of the SSM Integrated Healthcare Delivery System. The Director is responsible for the Quality Management Program which includes Health Promotion, HEDIS, CAHPS, HOS, NCQA accreditation, CMS Star Ratings management including mandated regulatory and accreditation projects. The Quality Leader has key accountability for achieving organizational targets for HEDIS and achieving 4 STAR or higher ratings from CMS on DHP’s Medicare Advantage product.
Essential Job Functions:
*Establishes strategic quality direction and manages staff. Director ensures clinical intervention activities are aligned to overall quality goals/plans and effectively implemented.
*Responsible for development of strategy of provider incentives, pharmacy programs, internal quality campaigns, and vendors related to, or impacting, quality metrics including STARS.
*Develop and implement quality improvement plans for HEDIS/STARS with continual monitoring of relevant quality measures. Provides analytics and report out of Stars and HEDIS results to senior leadership on progress monitoring.
*Develop provider and member outreach models and/or programming to close quality gaps while ensuring distinct owner/non-owner approaches are developed utilizing provider quality benchmarking and incentives.
*Responsible for NCQA readiness, accreditation, and ongoing compliance with NCQA requirements. Serve as subject matter expert on organizational committees.
*Provides leadership and oversight of employer-based health promotion strategy and programming.
Bachelor’s degree in relevant field of study with Quality certification, Master’s degree, or equivalent experience.
5+ years of experience working in health industry
3+ years of health plan quality management leadership experience with 2 years managing STARS
Medicare Advantage direct responsibility, extensive knowledge of and experience with NCQA, CMS and Stars, HEDIS, HOS, and CAHPS
Highly organized with excellent project management skills. Ability to drive business transformation and work well with senior leadership
Ability to organize and facilitate multidisciplinary workgroups with a systematic approach toward problems solving Excellent change management and operational skills. Proven ability to work autonomously, and build solid teams. Highly proficient at multi-tasking and prioritization multiple priorities
Ability to build key stakeholder and partnership relationships
SSM Health is a Catholic, not-for-profit health care system serving the comprehensive health needs of communities across the Midwest through one of the largest integrated delivery systems in the nation.
With care delivery sites in Illinois, Missouri, Oklahoma, and Wisconsin, SSM Health includes 20 hospitals, more than 60 outpatient care sites, a pharmacy benefit company, an insurance company, ...two nursing homes, comprehensive home care and hospice services, a technology company and two accountable care organizations.
?We are deeply rooted in our Mission? and Values and guided by a strong commitment that it takes exceptional people to provide an exceptional experience that will deliver exceptional care and value. We are committed to helping our talented employees continue to grow on a personal and professional level.