Director, Quality Improvement

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

📋 Description

• Lead and manage initiatives aimed at enhancing process efficiency and streamlining workflows.

• Collaborate with team members on NCQA Accreditation and/or HEDIS performance initiatives.

• Direct quality improvement efforts related to risk adjustment processes across all product lines.

• Work alongside the Medicare STARS team to enhance STARS ratings for Medicare offerings.

• Supervise provider satisfaction surveys and execute improvement action plans based on findings.

• Investigate and integrate best practices into operational processes.

• Organize and oversee activities, methods, and procedures to meet business objectives effectively.

• Evaluate and adopt new technological tools and processes while promoting teamwork with internal and external partners.

• Present outcomes of improvement initiatives and ongoing performance metrics to senior management.

• Develop and implement policies, operating procedures, and objectives in alignment with guidelines.

• Partner with State, County, and local agencies to advocate for services that enhance health outcomes, reduce health disparities, and lower care costs.

• Monitor the application of standards with agencies, community stakeholders, and local communities.

• Foster cultural competence within the health plan by implementing culturally inclusive best practices and training for providers.

• Supervise the assessment of provider-network cultural diversity, identify resource gaps, and create recommendations for credentialing and network development.

• Track and assess provider practices using KPIs and health equity dashboards.

• Manage population-specific initiatives, cultural treatment teams, and community support systems.

• Oversee the outcomes-based Cultural Competency Plan in accordance with CLAS standards and national and regional priorities.

• Utilize data-driven evaluations and strategies for ongoing monitoring and enhancement of culturally competent performance.

• Administer the outreach budget for Cultural Competency programs and sponsorships.

• Perform additional duties as assigned.

• Adhere to all organizational policies and standards.

⛳️ Requirements

• Must be a resident of Indiana or willing to relocate to Indiana.

• Bachelor's Degree in Nursing, a related field, or equivalent experience is required.

• A minimum of 7 years of experience in quality management, quality improvement, or healthcare operations is necessary.

• Specific states may require formal certification in quality improvement, risk management, or a related discipline.

• Current RN license in the state is preferred.

• Certification as a Professional in Health Care Quality is preferred.

• A Master's Degree is preferred.

• Ability to lead and collaborate on NCQA Accreditation and/or HEDIS performance is essential.

• Familiarity with Medicare STARS, including HEDIS, CAHPS, and HOS is required.

• Understanding of cultural competency, CLAS standards, health equity, and provider network assessment is necessary.

🏝️ Benefits

• Competitive salary.

• Health insurance coverage.

• 401K retirement plan.

• Stock purchase options.

• Tuition reimbursement opportunities.

• Paid time off along with holidays.

• Flexible work arrangements including remote, hybrid, field, or office schedules.

• Additional incentives may be included in the overall compensation package.

• Equal opportunity employer dedicated to promoting diversity.