32 applicants

Company

CareSource · 4 hours ago

VP, Quality & Performance Outcomes

United States

Full-time

Remote

Senior Level, Lead/Staff

10+ years exp

Maximize your interview chances

Health CareMedical

Comp. & Benefits

Insider Connection @CareSource

Discover valuable connections within the company who might provide insights and potential referrals.
Get 3x more responses when you reach out via email instead of LinkedIn.

Responsibilities

Establishes objectives and annual goals in conjunction with the Executive team

Establish the organizations Quality structure and strategy in collaboration with the market

Promotes organization-wide understanding, communication, and coordination of the Quality program

Oversees the quality dashboard reporting and analyzes the validity of data/reports

Ensures organization is compliant with NCQA Accreditation for products

Provides leadership for and supervises the member/provider satisfaction survey process

Provides leadership for the development, implementation, and evaluation of HEDIS strategy and action plans for all markets

Work closely with the market CMO’s in jointly establishing goals

Collaborate with the Enterprise clinical team and the markets in achieving the goals through evidence based interventions

Developing health literacy campaigns jointly with the market leadership

Supports External Quality Review Organization (EQRO) state audit processes

Provides HEDIS/Quality leadership representation in new business activities

Works with the Markets to establish their Quality structure & strategy

Provides leadership support and makes recommendations for provider re-credentialing in the areas of medical record reviews, Clinical Quality indicators, performance and quality of care actions

Assures compliance with all State and Federal HEDIS requirements

Develops & manages the annual operating and capital budgets

Oversees quarterly reporting of all HEDIS quality initiatives/results and state performance and bonus measures to all appropriate committees

Develop the goals, measurements, quality standards and tracking mechanisms for HEDIS with DSI and clinical informatics

Integrates HEDIS into provider strategy

Perform any other job duties as requested

Qualification

Find out how your skills align with this job's requirements. If anything seems off, you can easily click on the tags to select or unselect skills to reflect your actual expertise.

HEDIS operationsQuality managementQuality improvementRisk managementUtilization managementNCQA accreditationClinical data analysisURAC accreditationMicrosoft OfficePopulation health managementCritical thinking skills

Required

Bachelor Degree or equivalent work experience is required

Minimum of ten (10) or more years of current progressive, operational experience in HEDIS, quality management, quality improvement, risk management, and/or utilization management in a managed care setting

Five (5) years of strong senior level leadership/ management experience is required

Demonstrated management of multiple regulatory and accreditation areas covering a broad range of populations

Intermediate proficiency level with Microsoft Office (word, excel, PowerPoint) and reporting/database applications

Proven leadership skills

Process and outcome expertise

Ability to drive consensus and develop relationships across the organization; Collaborate across functional areas

Understand and integrate the role of HEDIS in the context of the regulatory environment

Clinical data analysis and trending skills

Effective oral and written communication skills

Attention to detail

Negotiation skills/experience

Decision making/problem solving skills

Knowledge of population health management

Strong organizational, analysis, and problem-solving skills

Knowledge of the political and regulatory environments

Critical listening and thinking skills

To help protect our employees, members, and the communities we serve from acquiring communicable diseases, Influenza vaccination is a requirement of this position. CareSource requires annual proof of Influenza vaccination for designated positions during Influenza season (October 1 – March 31) as a condition of continued employment. Employees hired during Influenza season will have thirty (30) days from their hire date to complete the required vaccination and have record of immunization verified.