Job Summary:

Vice President, Quality and Performance Outcomes is responsible for overseeing the Healthcare Effectiveness Data and Information Sets (HEDIS) operations for all markets and products including setting strategies for maximizing STAR ratings, recognizing withhold dollars and reporting.  Provides leadership to achieve target improvement goals.

Essential Functions:

• 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

Education and Experience:

• Bachelor Degree or equivalent work experience is required
• Graduate degree in business administration (MBA), nursing (MSN), or public administration (MPA) preferred
• 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
• Previous NCQA, URAC accreditation and HEDIS reporting knowledge and awareness is preferred
• Five (5) years of experience in a managed care organization, Medicaid, Medicare, and Long-Term Care is preferred

Competencies, Knowledge and Skills:

• 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
• Knowledge of trends in healthcare, managed care, Medicaid/Medicare, long term-care, NQQA and URAC accreditation and HEDIS/Quality
• 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

Licensure and Certification:

• 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.
• CareSource adheres to all federal, state, and local regulations. CareSource provides reasonable accommodations to qualified individuals with disabilities or medical conditions, sincerely held religious beliefs, or as required by state law to enable the employee to perform the essential functions of the position. Request for accommodations will be completed through an interactive review process.

Working Conditions:

• General office environment; may be required to sit or stand for extended periods of time

Compensation range $150,000-$300,000.  CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type (hourly/salary):

Salary

Organization Level Competencies

• Create an Inclusive Environment

• Cultivate Partnerships

• Develop Self and Others

• Drive Execution

• Energize and Inspire the Organization

• Influence Others

• Pursue Personal Excellence

• Understand the Business

 

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an inclusive environment that welcomes and supports individuals of all backgrounds.