Director, Market Quality Improvement

This is a fully remote position, open to applicants in Ohio.

📋 Description

• Direct activities to meet established quality objectives and enhance quality performance in designated markets.

• Implement the Quality Improvement program for assigned markets, ensuring adherence to NCQA accreditation, quality standards, and state regulations.

• Develop, organize, and annually oversee the Quality Improvement Program, Quality Improvement Plan, and QAPI processes.

• Collaborate with stakeholders to integrate recommendations and effectively communicate the Quality Improvement Program within specified timelines.

• Assess the previous year's Quality Improvement Program and collaboratively create the work plan for the upcoming year.

• Analyze member risk and quality data to enhance quality performance and member care across various organizational business lines.

• Lead and/or chair workgroups and committees aimed at improving quality measure outcomes.

• Work with enterprise business owners to deliver quality-related standards within established deadlines.

• Review, audit, and oversee quality improvement and performance enhancement initiatives.

• Address administrative inquiries regarding quality issues or audits and manage corrective action plans.

• Supervise root cause analyses, ensuring data is effectively presented and utilized to tackle quality and performance improvement challenges.

• Engage in community-based Quality Improvement initiatives.

• Establish and uphold standards and procedures for quality reporting and documentation.

• Communicate strengths and areas for improvement during Quality Committees.

• Represent CareSource in external engagements with state committees, consultants, representatives, and accreditation authorities.

• Oversee performance improvement projects mandated by state regulators.

• Ensure compliance with regulatory quality reporting requirements while maintaining awareness of business, regulatory, and accreditation environments.

• Assist with budgeting and financial forecasting/analysis.

• Contribute to strategic planning and prioritize staff workloads.

• Perform other related duties as assigned.

⛳️ Requirements

• Residency in Ohio is mandatory.

• A Bachelor of Science in Nursing (BSN) or a degree in healthcare, business, management, or a related field is required.

• A minimum of five (5) years of leadership or management experience is required.

• At least three (3) years of experience in Medicaid or a managed care organization is necessary.

• A minimum of five (5) years of experience in healthcare quality, including the development, implementation, and/or evaluation of Quality Improvement Programs, is essential.

• Experience with data collection, analysis, and trend evaluation of processes and outcomes is required.

• Intermediate computer proficiency is necessary; must be skilled in Microsoft Word, Excel, and PowerPoint.

• Demonstrated understanding of the complex healthcare industry, including health plans and business processes related to quality and performance improvement, as well as quality methodologies.

• Proven experience in a high-growth business environment.

• Strong presentation skills are essential.

• Ability to thrive in a demanding environment and rapidly adjust priorities as needed.

• Effective critical thinking abilities with a keen attention to detail.

• Capability to set, prioritize, and achieve goals.

• Strong written and verbal communication skills, with the ability to collaborate across multidisciplinary departments within the organization.

• Excellent interpersonal skills and a high level of professionalism.

• Ability to work autonomously as well as part of a team.

• Strong active listening and critical thinking skills.

• Strategic leadership and management capabilities.

• Customer service and member-focused orientation.

• Certification as a Professional in HealthCare Quality (CPHQ) by the National Association for Healthcare Quality (NAHQ) is required within six (6) months of employment.

🏝️ Benefits

• Competitive base salary.

• Potential bonuses linked to individual and company performance.

• Comprehensive and substantial total rewards package.

• Equal Opportunity Employer that fosters an environment of belonging and support for individuals from diverse backgrounds.