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Director Quality Improvement, Health Services, SHP

Job ID 84387 Date posted 11/15/2017
  • Facility: Sharp HealthPlan
  • City: San Diego
  • Department: Health Services
  • Category: Executive Jobs
  • Job Status: Full-Time
  • Shift: Day Job
  • FTE: 1.0
  • Shift Start: Variable
  • Shift End Time: Variable
Director Quality Improvement - Sharp Health Plan
Sharp Health Plan is the largest locally based commercial health plan in San Diego. We are a not-for-profit health plan that has been serving San Diego and southern Riverside Counties since 1992. As a subsidiary of Sharp HealthCare, we are backed by the largest provider of comprehensive health care services in San Diego.
 
Sharp Health Plan offers a variety of coverage options that combine affordability and choice, while delivering high quality health care and personal service. We provide health insurance for companies of all sizes throughout the region. Members have access to valuable plan enhancements, such as interactive wellness resources, dental discounts and our exclusive global emergency services program.
 
Summary:
Director Quality Improvement will provide effective leadership in Sharp Health Plan-wide quality improvement activities offering guidance, tools and encouragement to management and staff toward continuous quality improvement for process improvement leading to efficiency, cost effectiveness and higher levels of customer and provider satisfaction. Will provide leadership and management of the processes, structure and systems required to maintain NCQA accreditation and satisfy all CMS program requirements for
quality programs and reporting. Provide leadership and direction to the delegation oversight program for enhanced provider and member satisfaction and to ensure NCQA and regulatory compliance with CMS and the CA Department of Managed Health Care.
Provide leadership and operational management for Pay for Performance incentive programs across the provider network. Will participate as part of and in support of a management team that operationalizes and ensures success of Sharp Health Plan’s goals, objectives, and strategic initiatives.
 
Required Skills and Qualifications:
  • Ten (10) years’ leadership and management experience with a focus on NCQA accreditation
  • Five (5) years’ experience in an HMO setting responsible for data and NCQA-compliant quality management programs.

Education: 

  • Master’s degree in Management, Public Health, or other healthcare related degree.
  • Combination of education and managed care experience required.
  • Master’s degree in business or public health preferred.
  • Clinical and/ or physician group quality management experience recommended.
 
Licensure:  RN preferred
 
 

Director Quality Improvement
Key Responsibilities:
  • Responsible for the management and direction of the Quality Management (QM) department and all related activities.
  • Establishes quality improvement objectives; develops and implements the comprehensive Quality Management Program to meet the demographic and epidemiological needs of the population served and provide high quality and culturally appropriate care.
  • Ensures compliance with federal, state, and accreditation standards by developing, implementing and maintaining compliance processes within the department.
  • Maintains audit readiness, by ongoing training, competency assessment, audit, monitoring of metrics and corrective action.
  • Promotes plan-wide understanding, communication, and coordination of QM programs.
  • Investigates adverse occurrences and quality complaints;
  • Responsible for ensuring compliance and providing direction and guidance on clinical quality improvement and management programs including National Committee for Quality Assurance (NCQA).
  • Responsible for the reporting and analyzing of member care quality and for the development of plans and programs to support continuous quality improvement using HEDIS, CAHPS and other tools.
  • Ensures necessary steps are taken to achieve a successful year over year improvement of HEDIS measures.
Compensation and Benefits:
The position provides a very competitive compensation, including opportunity to participate in an entity incentive program along with a generous benefit package.
Physical Requirements:
  • Incumbent spends approximately 4-6 hours per day sitting at desk, entering data on computer terminal and talking on telephone.
  • Incumbent spends approximately 1-2 hours per day walking between Plan departments.
  • Must be able to hear and speak clearly by telephone. Must be able to meet frequent deadlines and tight schedules.
  • Must be able to lift 5 – 20 pounds, primarily paper reports and filing. Some use of personal automobile to meet with OON facilities, providers, health plans and attend meetings.
Additional physical requirements may be discussed during the interview
“Sharp HealthCare is proud to be an Equal Opportunity/Affirmative Action Employer.  All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, gender identity, transgender status, sexual orientation, protected veteran status or any other protected class.”
Keywords: Director Quality Improvement – Sharp HealthPlan, NCQA, HEDIS, Managed Care, HQI, Insurance Service Lines, Marketplace insurance jobs, Commercial Healthplan jobs, CMS, Sharp HealthPlan jobs, California healthplan jobs, Sharp HealthCare jobs

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