Job Summary: The Senior Director, Performance Improvement provides strategic leadership in the planning, development, implementation and execution of all aspects of a robust portfolio of value-based programs and strategies within the Prominence Health umbrella. Emphasis will be centered around risk-based contract performance, risk adjustment, and quality measurement performance across various Prominence Health business entities and partnerships. The most immediate focus for this position will be Riverside Medical Clinic and the advancement of its value based MSO strategy. The objective of this position is to optimize clinical quality and revenue opportunities for Prominence Health entities as well as to develop out a centralized support layer across businesses to enable reliable, scalable, high-performance operations in support of value based performance.

Key responsibilities include optimizing revenue opportunities by ensuring members receive appropriate medical care that is accurately coded so that the members' risk scores are optimized and compliant with regulatory reporting standards. The Senior Director has programmatic oversight and responsibility for achieving all risk adjustment, quality, and overall value based contract performance outcomes. The Senior Director works closely with partner stakeholders and business leaders to ensure the development and implementation of population health and quality improvement initiatives aligned with Prominence Health's clinical, business, quality measurement, and improvement strategies. The Senior Director will advise on best practices, leverage centralized Prominence Health resources, and enable the businesses supported to develop the competencies and programs that will achieve top tier performance.

Must work collaboratively with other Prominence Health and UHS partner organizations, including Actuarial, IS, Legal, Health Services, Network Management, Quality Improvement and others to manage the risk adjustment and quality measurement process. Must develop or recommend the purchase tools that will result in leveraging information to manage member analytics in order to more effectively direct resources and activities to meet risk adjustment and quality measurement objectives. In carrying out these responsibilities, The Senior Director works closely with external vendors and consultants, runs outsourced health risk assessment programs, develops training programs & tools to address the educational needs of providers and non-clinical staff, assists in the development of analytic and reporting tools, and assists in the development of data collection systems and workflows to fulfill CMS and quality measurement requirements

Qualifications and Regulatory Requirements:

• Master's Degree in Business Administration, Finance, Health Care Administration, Management or related field preferred.
• At least 5 years of health care experience working with value based Medicare Advantage STARS/HEDIS programs.
• At least 3 years of health care experience working with Medicare and/or Commercial risk adjustment programs. Requires working knowledge of CMS risk adjustment methodologies and quality improvement measures.
• Ability to effectively communicate in English, both verbally and in writing.
• Knowledge of regulatory quality-based reporting and audit requirements;
• Proficiency in interpreting results and formulating recommendations/action plans;
• Ability to research and analyze state/federal regulations related to health insurance and healthcare;
• Demonstrated skills in critical thinking, problem-solving, and the analysis, interpretation and evaluation of complex information;
• Excellent computer skills. Microsoft Office Suite
• Personable and demonstrated ability to develop and maintain relationships at all levels.
• Well organized and demonstrate strong attention to the detail
• Ability to understand, present and analyze data.
• Strong verbal and written communication skills.
• Versatile and flexible. Inquisitive mind with strong analytical skills and the ability to do complex problem solving.
• Strong project management, meeting process and presentation skills.

EEO Statement

All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws.

We believe that diversity and inclusion among our teammates is critical to our success.

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