Director - Quality Programs

We're excited about the potential people bring to our organization. You can grow your career here while enjoying first-class perks, benefits and commitment to diversity and inclusion.

The Director-Quality Program is a scientific leader who utilizes academic skills while working in tandem interdepartmentally with Informatics and HCS/PHM Operations. They work collaboratively to apply results of data analyses to Independent Health's specific settings and contexts to support improvement in quality of care and health outcomes as measured by HEDIS, Medicare Star, and QARR, including parameters that reflect the organization's health equity goals. The Director builds organizational commitment to continuous quality improvement, through collaboration and mutual learning; works in partnership with senior leadership to implement the organizational approach to quality improvement; provides expertise and education regarding quality improvement; and facilitates a comprehensive quality improvement program.

The Director has oversight of the identified/approved operations, quality, population health, and medical management plans/roadmaps in support of both departmental and organizational objectives as managed by the program delivery team and is responsible for providing leadership and development for the team. The Director is accountable for compilation and submission of key quality performance requirements for Medicare Star, Medicaid QARR, and Commercial NCQA HEDIS and CAHPS reporting. They are accountable for planning and content reported to Quality Review Oversight Committee and responsible for directing quality-related arrangements with external entities. The Director is responsible for, through a lens of health equity: 1) staying current on new and emerging best practices, innovative frameworks, strategies, health, and social care relevant to the work of population health management, and 2) including national or regional trends in population health delivery, remaining cognizant of the diverse medical, behavioral, and social needs of our local population. They are responsible for developing and leading a collaborative process with multiple departments to formulate strategic priorities around quality and health equity that support high quality care and service for our members. They endeavor to ensure strategies to improve quality are implemented and sustained as required. They are also responsible for the continued development, scaling, and optimization of operations and products specific to the Office of Science.

• Bachelor's degree required. Master's degree in health care administration, public health, epidemiology, or other health-related advanced degree preferred. An additional four (4) years of experience will be considered in lieu of degree.
• Eight (8) years of experience in quality management, population health management, or healthcare quality analytics required; managed care setting preferred.
• Five (5) years of progressive quality leadership required.
• Must have a strong understanding of healthcare delivery systems and processes including solid understanding of the principles for quality, patient safety, risk management, methodologies for continuous improvement, system thinking and behavioral science.
• Must have a solid grounding in principles underlying evaluation of community health, including assessment, assurance, and policy development and promulgation.
• Experience establishing, pursuing, and monitoring appropriate process and outcome measures for key initiatives using a systems perspective; evaluating the processes by which clinical care and patient services are delivered within and across populations; identifying areas of opportunity, setting standards for outcomes, developing appropriate systems to monitor outcomes, and overseeing the implementation of process improvements.
• Change management skills in a complex healthcare environment.
• Expert knowledge of NCQA Health Plan Accreditation, HEDIS, QARR, and Medicare Star is required.
• Proven ability to lead or influence others positively to achieve desired work results and ability to work effectively with others to achieve common goals.
• Proven examples of displaying the IH values: Passionate, Caring, Respectful, Trustworthy, Collaborative, and Accountable.

• Lead through influence and provide oversight of the organization's quality program, including the functions of health plan accreditation and quality improvement, in a highly matrixed work environment.
• Establish productive working relationships with internal teams to build a collaborative continuum of support for quality management and health care quality improvement activities.
• Develop annual and long-range quality plans. Oversee Independent Health's quality improvement system including but not limited to selection of measures, benchmarking, and target setting.
• Ensure ongoing/timely review of key performance indicators/metrics to produce recommendations for ongoing organizational efforts.
• Oversee and monitor timely compilation and submission of key quality performance metrics, reports, work plans and narratives required for Medicare Star, Medicaid QARR, and Commercial NCQA HEDIS and CAHPS reporting, including ensuring consistency and adherence to all requirements, including those related to health equity.
• Represent the plan and build communication paths with regulatory external quality entities including, NYSDOH and CMS, as needed.
• Continue to evolve an effective quality management program system built on quality planning, quality control, and quality improvement using established improvement scientific methodologies.
• Create and maintain an environment of continuous improvement utilizing PDSA methodology.
• Ensure the organization-wide quality management program adheres to all accreditation, state, and federal standards and that the organization is poised to be continuously survey prepared.
• Develop formal pathways of collaboration within PHM and with other internal stakeholders including Sales/Marketing, Compliance, Product, RedShirt, and Member Experience for informing, supporting, and optimizing initiatives.
• Provide input and oversight of the plan's quality arrangements with external entities, including but not necessarily limited to Primary Value, IPA arrangements, and provider incentives, as well as member incentives.
• Lead through influence and collaboration with internal and external stakeholders to develop, scale, and optimize the organization's approach to health equity, with particular emphasis on defining goals and objectives with reference to PHM needs, understanding barriers and opportunities, contributing to solutioning as appropriate, and identifying and reinforcing relevant quality initiatives.
• Prepare strong, insightful, and strategic level presentations and summaries for a variety of stakeholders, committees, and oversight boards. Participate in meetings upon request.
• Ensure compliance with the corporate risk management plan and other regulatory requirements across span of control.
• Maintain strict adherence to state and federal compliance policies by ensuring a prompt response to detected offenses and regular oversight and reporting of potential compliance risk areas.
• Support the continued development and scalability of academic partnerships.
• Support the growth of the Office of Science, which aims to build the organization's reputation as a science-oriented partner in support of PHM's goals and objectives.
• Represent the best interests and brand of Independent Health in the community and with internal and external key stakeholders as required.
• Protect confidential business information and data to minimize risk to the organization. Respect information gleaned through the course of duties and disclose only minimum necessary when required.

Immigration or work visa sponsorship will not be provided for this position

Hiring Compensation Range: $125,000 - $150,000 annually

Compensation may vary based on factors including but not limited to skills, education, location and experience.

In addition to base compensation, associates may be eligible for a scorecard incentive, full range of benefits and generous paid time off. The base salary range is subject to change and may be modified in the future.

As an Equal Opportunity / Affirmative Action Employer, Independent Health and its affiliates will not discriminate in its employment practices due to an applicant's race, color, creed, religion, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender identity or expression, transgender status, age, national origin, marital status, citizenship and immigration status, physical and mental disability, criminal record, genetic information, predisposition or carrier status, status with respect to receiving public assistance, domestic violence victim status, a disabled, special, recently separated, active duty wartime, campaign badge, Armed Forces service medal veteran, or any other characteristics protected under applicable law. Click here for additional EEO/AAP or Reasonable Accommodation information.

Current Associates must apply internally via the Job Hub app.