Director, Market Quality Improvement

Job not on LinkedIn

🔥 13 hours ago

🏈 Ohio – Remote

🏈 Ohio – Remote

💵 $113k - $197.7k / year

⏰ Full Time

🔴 Lead

👔 Director

🦅 H1B Visa Sponsor

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CareSource

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 30+ years

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

CareSource is a health services company focused on providing affordable health insurance and healthcare solutions. It offers a wide range of plans including Medicaid, Marketplace, and Medicare Advantage, targeting low-income adults, families, children, pregnant women, elderly adults, and people with disabilities. Additionally, CareSource provides members with resources for COVID-19 support, dental, vision, and hearing benefits, as well as pharmacy services. The company emphasizes easy access to healthcare management through online platforms and a mobile app.

📋 Description

• Direct activities to achieve defined quality goals and outcomes and improve quality performance for assigned markets • Execute the Quality Improvement program for assigned markets while ensuring compliance with NCQA accreditation, quality requirements, and state requirements • Develop, organize, and monitor the Quality Improvement Program, Quality Improvement Plan, and QAPI processes annually • Collaborate with stakeholders, incorporate recommendations, and communicate the Quality Improvement Program within defined time limits • Evaluate the prior year’s Quality Improvement Program and collaboratively develop the upcoming year’s work plan • Analyze member risk data and quality data to improve quality performance and member care across organizational lines of business • Oversee and/or chair workgroups and committees to improve quality measure outcomes • Collaborate with enterprise business owners to deliver quality-related standards within defined timeframes • Review, audit, and monitor quality improvement and performance improvement activities • Respond to administrative inquiries related to quality issues or audits and oversee corrective action plans • Oversee root cause analyses and ensure data is effectively presented and used to address quality and performance improvement issues • Participate in community-based Quality Improvement initiatives • Establish and maintain standards and procedures for quality reporting and documentation • Communicate strengths and opportunities for improvement through Quality Committees • Represent CareSource externally to state-based committees, consultants, representatives, and accreditation authorities • Oversee performance improvement projects directed by state regulators • Ensure compliance with regulatory quality reporting requirements and maintain knowledge of business, regulatory, and accreditation environments • Aid in budgeting and financial forecasting/analysis • Assist in strategic planning and prioritize staff workload • Perform other related duties as requested

🎯 Requirements

• Ohio residency required • Bachelor of Science in Nursing (BSN) or other degree in a healthcare, business, management or related field is required • Minimum of five (5) years of leadership/management experience is required • Minimum of three (3) years of experience in Medicaid, or a managed care organization is required • Minimum of five (5) years of healthcare quality experience, including developing, implementing and/or evaluating Quality Improvement Programs, is required • Experience in data collection, analysis and trending of processes and outcomes • Intermediate computer skills; proficient in Microsoft Word, Excel, and PowerPoint • Demonstrated understanding of complex healthcare industry, health plan and business processes specific to quality and performance improvement, and quality methodology • Demonstrated experience in a high-growth business environment • Strong presentation skills • Ability to work in a demanding environment and quickly reprioritize based on needs • Effective critical thinking skills with attention to detail • Ability to develop, prioritize and accomplish goals • Effective written and verbal communication skills and ability to work with multidisciplinary departments across the organization • Strong people skills and high level of professionalism • Ability to work independently and within a team environment • Active listening and critical thinking skills • Strategic leadership/management skills • Customer service, member-focused orientation • Certified Professional in HealthCare Quality (CPHQ) by the National Association for Healthcare Quality (NAHQ) within six (6) months of employment is required

🏖️ Benefits

• Base compensation • Potential bonus tied to company and individual performance • Substantial and comprehensive total rewards package • Equal Opportunity Employer environment focused on belonging and support for individuals of all backgrounds