JOB SUMMARY

The Director for Quality is responsible for developing, administering and managing the Medicare Stars program, and other quality improvement processes and programs (HEDIS, CAHPS and HOS) to support the objectives of providing high quality care and service to our members.  The Director is responsible for strategic planning and contributes knowledge to assist executive team in the decision-making process for future strategies. The Director oversees the delegated partners to ensure that program objectives are met.  Working across the company, the Director will identify, direct and lead programs to achieve company desired Star ratings and quality incentive bonus program improvements; and all processes are in compliance with applicable laws and regulations.  

ESSENTIAL DUTIES AND RESPONSIBILITIES

This position must be able to:

• Collaborates with executive leaders and outside agencies/vendors regarding strategic planning and execution of various quality projects.  Strategically conceptualize future tools and processes for the success of HTA and maintain focus on outcomes. Serves as a resource for multiple committees within HTA and third-party vendors regarding quality and Stars. Directs implementation of the strategic plans for quality programs (including Stars, HEDIS, CCIP), including improved approaches to structure and effectiveness for processes
• Leads and directs the quality programs to continually assess the tactical processes to achieve program objectives; identifying and quantifying key drivers of the Star measures and Display measures; identifying areas of opportunity and improvement; and creating programs to address each
• Oversees the relationship with vendors including performance oversight, quality reviews, corrective actions (and education and training) to improve performance and/or compliance with regulations, and ensures all required reporting is accurate, timely and complete.
• Oversees the build and maintenance of education programs for physicians by delegated partners to ensure that plan goals are communicated appropriately
• Develops, analyzes and communicates regular reporting on key performance metrics to leadership
• Performs other duties as assigned
• Supports and oversees implementation of work plans, establishes deadlines, assigns responsibilities, and monitors project progress, and reports progress regularly to internal stakeholders for the, Stars Program, Healthcare Effectiveness Data and Information Set (HEDIS), Health Outcomes Survey (HOS), Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys
• Oversee daily operations HTA staff which includes performance improvement and quality. Ensure data is accurate, reliable and valid for reporting purposes either to HTA leaders, providers, or other outside entities.  Collaborate with leaders of all levels to ensure consistency of priorities in quality and to ensure alignment of quality goals.  Direct processes and standards that support business goals. Oversee, ongoing monitoring of governmental changes in reporting and quality metric criteria that is HEDIS, Star and Plan related.
• Supports and oversees the development of quality improvement initiatives, Chronic Care Improvement Projects (CCIP) as for Medicare Advantage Organizations.  Collects, analyzes, summarizes information and trends, consults on research projects, and recommends actions to improve quality measures in support of Star rating goals.
• Works collaboratively across the organization to leading quality initiatives and supporting compliance/audit requirements as needed
• Leads staff assigned to Medicare Stars, HEDIS; provides guidance and mentoring of staff; and builds effective teams (both internally and with vendors) to achieve established goals and within established budgets
• Demonstrates the ability to lead and influence others positively to achieve desired goals of HTA

EDUCATION AND EXPERIENCE

Education:

• Bachelor’s Degree required in Healthcare or Business-related fields or years equivalent work experience

Required Experience:

• Clinical Licensure
• Two plus years’ experience with Medicare Stars program and improvement strategies
• Proficient in Word, Excel and PP
• Post Graduate Residency or 5+ years equivalent healthcare experience
• Knowledge of HEDIS process and measure experience
• Five plus years’ experience working in healthcare setting with focus on monitoring and analyzing projects
• Two plus years of Managed Care or Accountable Care Organization experience
• Five plus years’ Experience with vendor oversight

Preferred Experience:

• Master of Health Administration, Master of Business Administration or Pharmacy Administration, or other advanced degree in pharmacy or healthcare leadership
• Experience working with regulatory agencies (CMS)
• Five plus year Managed Care Organization or Accountable Care Organization experience
• Experience leading/ coordinating initiatives
• Experience performing clinical data analysis 

Other Requirements:

• COVID-19 Vaccine    
• Annual Flu Vaccine

KNOWLEDGE, SKILLS, AND ABILITIES

Required Competencies:

• Working knowledge of HEDIS, CAHPS, HOS and NCQA
• Working knowledge of Medicare Advantage and Part D laws and regulations
• Strong in the following competencies:
  • Decision making/Judgment
  • Problem solving/Analysis
  • Communication
  • Creativity/Innovation

Preferred Competencies:

• Familiarity with ICD-10

PHYSICAL REQUIREMENTS

• Exerting up to 10 pounds of force occasionally (up to 1/3 of the time) and/or;
• A negligible amount of force frequently (1/3 to 2/3 of the time) to lift, carry, push, pull, or otherwise move objects, including the human body.
• Sedentary work involves sitting most of the time but may involve walking or standing for brief periods of time.
• Jobs are sedentary if walking and standing are required only occasionally, and all other sedentary criteria are met.

ABOUT HEALTHTEAM ADVANTAGE

HealthTeam Advantage is an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran, or disability status.

HealthTeam Advantage (HTA), a Greensboro-based health insurance company, offers Medicare Advantage plans to eligible Medicare beneficiaries in 33 North Carolina counties. HTA has been named a “Best Places to Work” finalist three times by Triad Business Journal. To learn more, visit HealthTeamAdvantage.com