Community Health Plan of Washington · 1 month ago
Senior Director, Quality Ratings & Network Performance
Seattle, Washington, United States
Full-time
Onsite
Senior Level, Lead/Staff
$180K/yr - $210K/yr
10+ years expCommunity Health Plan of Washington is an equal opportunity employer committed to a diverse and inclusive workforce. The Senior Director, Quality Ratings and Network Performance leads strategic initiatives to improve health plan quality ratings and provider performance, focusing on Medicaid, Exchange, and D-SNP populations, while ensuring compliance with regulatory requirements.
Health Care
Responsibilities
Lead strategy and execution for Health Plan ratings strategies (e.g., NCQA, VBP, P4P, EQRO) and D-SNP Stars ratings
Lead data collection and validation for official HEDIS, CAHPS and HOS reporting to regulatory bodies
Monitor and analyze performance across HEDIS, CAHPS, and other key health plan rating measures; collaborate with Quality/Population Health leaders to develop and execute targeted improvement plans
Collaborate with internal teams to ensure accurate and timely data submission to CMS and state agencies
Facilitate and/or oversee the organization’s cross-functional Star Improvement Committee, as well as cross-departmental collaborative meetings focused on Health Plan rating measure strategies
Manage vendor contracts and provide vendor oversight, including monitoring key performance indicators and ensuring adherence to contract terms to support Star and/or quality programs
Develop and implement provider engagement strategies to improve quality outcomes for Medicaid, Exchange and D-SNP members
Partner with network management, clinical operations, and analytics to identify performance gaps and drive improvement
Lead clinic partnerships and data integration team to effectively deploy practice transformation and quality coaching models with the CHC network
Oversee strategies to leverage provider-facing tools, dashboards, and education to support quality and compliance goals
Lead a cohesive and motivated team of professionals and analysts focused on employing continuous quality improvement techniques leveraging data effectively to support rapid cycle improvements in performance
Serve as a strategic advisor to executive leadership on quality trends, risks, and opportunities
Foster a culture of accountability, innovation, and continuous improvement
Collaborate with leaders in Clinical Services and across the organization to identify and facilitate improvement projects to enhance organizational performance on quality measures
Lead and collaborate with internal and external stakeholders to ensure Stars, CAHPS/HOS and other quality measurement initiatives are fully integrated throughout the organization, maximizing opportunity to improve outcomes for members
Set and manage department budget, as applicable
Other duties as assigned. Essential functions listed are not necessarily exhaustive and may be revised by the employer, at its sole discretion
Qualification
Required
Possess a Bachelor's degree in healthcare administration, public health, nursing, healthcare economics, or related field, a Master's degree is highly preferred
Have ten (10) + years of experience in healthcare quality, performance improvement, or healthcare analytics, with a focus on Medicaid, Exchange and/or D-SNP
Have a minimum of seven (7) years of progressive leadership experience
Possess a deep knowledge of CMS Stars, HEDIS, CAHPS, HOS and Medicaid-specific quality programs
Have proven leadership in managing cross-functional teams and complex initiatives
Are highly skilled in analytics, communication, and strategic planning
Experience with state Medicaid programs and CMS D-SNP regulations
Ability to translate data into actionable insights for diverse stakeholders
Knowledge of HEDIS, CAHPS, HOS, and Stars requirements and their impact on the organization
Independent and complex problem-solving skills; including the ability to assist others in working through complex problems to meet desired outcomes
Analytical skills and the ability to interpret, evaluate and formulate action plans based upon data
Verbal and written communication skills, including the ability to present in front of a variety of audiences
Ability to set performance expectations, coach for performance success, and achieve department and company objectives
Ability to add insight and value to corporate initiatives, including program evaluation and innovation
Complete and successfully pass a criminal background check
Has not been sanctioned or excluded from participation in federal or state healthcare programs by a federal or state law enforcement, regulatory, or licensing agency
Vaccination requirement (CHPW offers a process for medical or religious exemptions)
Preferred
A Master's degree is highly preferred
Benefits
Medical, Prescription, Dental, and Vision
Telehealth app
Flexible Spending Accounts, Health Savings Accounts
Basic Life AD&D, Short and Long-Term Disability
Voluntary Life, Critical Care, and Long-Term Care Insurance
401(k) Retirement and generous employer match
Employee Assistance Program and Mental Fitness app
Financial Coaching, Identity Theft Protection
Time off including PTO accrual starting at 17 days per year.
40 hours Community Service volunteer time
10 standard holidays, 2 floating holidays
Compassion time off, jury duty pay.
Company
Community Health Plan of Washington
For over 30 years, Community Health Plan of Washington (CHPW) has been providing quality health care to Washington families and supporting your choices for health care.
501-1000 employees
H1B Sponsorship
Community Health Plan of Washington has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (3)
2024 (2)
2023 (1)
2022 (2)
2020 (1)
Funding
Current Stage
Late StageLeadership Team
Leanne Berge
Chief Executive Officer
Stacy Kessel, CPA
Chief Financial Officer
Recent News
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