Director, Quality & Process Improvement, HEDIS Audit

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

📋 Description

• Lead and manage initiatives aimed at process improvement by employing methodologies to analyze existing operations and design enhancement projects across all operational areas.

• Facilitate NCQA HEDIS audit readiness and compliance, ensuring timely and accurate submissions.

• Oversee daily activities related to audit readiness, which include Roadmaps, Section 5 documentation, Measure Specifications, CAHPS coordination, and engagement with auditors.

• Supervise the administration, coordination, and evaluation of quality assurance and training programs.

• Direct the implementation of performance improvement projects, which encompass process mapping and design, including timelines and deliverables for HEDIS audits.

• Act as the primary liaison for auditors and leadership, supporting audit communications and achieving successful outcomes.

• Develop and maintain dashboards, communications, and strategies to enhance overall effectiveness.

• Research and formulate best practices, policies, procedures, and goals in alignment with both internal and external guidelines.

• Manage data analysis and collection processes to assess the costs and benefits of process effectiveness and efficiency.

• Ensure that the business unit adheres to URAC and Joint Commission Accreditation standards.

• Evaluate and implement new technological tools and processes.

• Foster strong collaborative relationships with all functional units and their leaders.

⛳️ Requirements

• Bachelor's Degree in a relevant field.

• Over 6 years of experience in quality and process improvement.

• Preferably possess experience in the healthcare industry.

• Familiarity with research methodologies, including measures and outcomes.

• Proficient in process mapping, process design, and workflow management software and applications.

• Experience with URAC and Joint Commission Accreditation is preferred.

• Strong preference for candidates with experience in NCQA HEDIS measures or audit processes.

🏝️ Benefits

• Competitive pay.

• Health insurance.

• 401K and stock purchase plans.

• Tuition reimbursement.

• Paid time off plus holidays.

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