Carolina Complete Health · 2 weeks ago
Vice President, Quality Management
North Carolina, United States
Full-time
Hybrid
Lead/Staff, Director/Executive
$172K/yr - $327K/yr
5+ years expCarolina Complete Health is transforming the health of communities, and they are seeking a Vice President of Quality Management to oversee the quality management program for the Health Plan Division. This role involves leading the development and implementation of quality programs, ensuring compliance with accreditation standards, and managing the quality team.
Hospital & Health Care
Responsibilities
Leads the development and implementation of the HPD’s Quality Program and ensures national consistency of best practices for all members and providers
Acts as advisor and consultant to business unit leadership on processed and outcomes related to the accreditation program
Leads monitoring and audit preparation activities to ensure the health plan and contracted network processes are in compliance with regulatory and accreditation agencies
Leads and oversees the Delegated Oversight Department and ensures delegated provider and clinical vendor performance are in compliance
Leads and participates in national and regional committees that promote and oversee quality, accreditation programs and initiatives to monitor the quality of care, delivery and access
Ensures compliance with company standards related to clinical measurement programs transparency, data exchange, ethics and public reporting
Develops and implements provider education/intervention programs for aberrant or outlier care practices including development of clinical evidence-based clinical guidelines
Participates in the implementation of medical program strategic development and deployment in collaboration with the Medical Integration team
Programs include, but are not limited to, Wellness, Preference Sensitive Conditions, Disease State Management, Chronic Conditions and Special Populations
Works collaboratively with various HPD departments to manage health care outcomes and trends including implementing mechanisms to leverage national and local network management agreements
Leads the process to monitor the effectiveness of all quality-related programs
Oversees the design, implementation and monitoring of enterprise-wide customer satisfaction measurement and initiatives to improve the customer’s perception of services
Collaborates with national HEDIS team in the data collection process at the provider level and leads national/regional data analysis and member/provider strategy and interventions
Directs the preparation of short-term and long-range plans and budgets
Leads management of the quality team and drives staff development opportunities
Qualification
Required
Bachelor's Degree in a clinical science or related health care field required
5+ years managed care experience with knowledge of accreditation standards and regulatory requirements required
5+ years clinical experience required
5+ years quality management experience required
Demonstrated leadership experience in health plan operations and local delivery system
Experience with and in-depth understanding of accrediting organizations and federal and state regulations and requirements
Current, valid and unrestricted licensed clinician (e.g. LCSW, RN, MD, DO, PhD/PsyD, etc.) required
Preferred
Master's Degree preferred
Benefits
Competitive pay
Health insurance
401K
Stock purchase plans
Tuition reimbursement
Paid time off plus holidays
Flexible approach to work with remote, hybrid, field or office work schedules
Company
Carolina Complete Health
Carolina Complete Health is a provider-led health plan established to deliver Medicaid Managed Care in North Carolina.
201-500 employees
Funding
Current Stage
Growth StageLeadership Team
Paula Shearon
Vice President, Chief Compliance Officer
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