Director, Statewide Quality California Medicaid

Healthcare

Director, Statewide Quality California Medicaid

Exp 10-15 yrs

Deg Bachelors

Relo

Bonus

Occasional Travel

Job Description

Director Clinical QM AGP Plan - LgPln

This is a statewide position that will oversee all quality and NCQA activities for the CA Medicaid Business, reporting to the Chief Medical Officer.  Primary duties may include, but are not limited to:

•                   Provides leadership for implementation of The Quality Management Program for the assigned California Health Plan.

•                   Establishes annual goals and objectives.

•                   Promotes understanding, communication, and coordination of the Clinical Quality Management Program.

•                   Oversees Quality Management (QM) Scorecard reporting.

•                   Provides leadership for the development, implementation, and evaluation of Clinical Quality improvement action plans.

•                   Provides leadership for the member/provider satisfaction survey process.

•                   Oversees Health Employer Data Information Sets (HEDIS) reporting and the development of action plans to achieve target improvement goals.

•                   Supports the Health Plans External Quality Review Organization (EQRO) state audit processes.

•                   Participates in the Quality Improvement Council (QIC).

•                   Supports compliance with National Committee for Quality Assurance (NCQA) standards or other accrediting bodies.

•                   Hires, trains, coaches, counsels, and evaluates performance of direct reports.

Qualifications

•                   Requires a BA/BS.

•                   10 years of experience in quality management.

•                   HEDIS, and health plan experience preferred.

•                   RN, MBA, MPH, or additional Quality certifications preferred.