What are the responsibilities and job description for the Director of Quality Improvement position at Genuine Health Group LLC?
dinorahcdc@gmail.com
Summary
The Director of Quality Improvement oversees and directs all aspects of the organization’s quality improvement initiatives with a primary focus on ensuring compliance and regulatory standards with HEDIS, ACO/CMS Quality Strategy and collection measures, by analyzing data, identifying areas for improvement, implementing strategies, and monitoring progress to achieve optimal patient outcomes across various clinical domains.
Essential Duties and Responsibilities
• Quality Improvement (QI) strategy development: identifying key QI priorities alighted with HEDIS measures and organizational goals. Developing and implementing comprehensive QI plans with clear objectives, metrics, and timelines; designing and executing targeted interventions to address identified gaps in care based on HEDIS data analysis.
• Reporting and Communication: presenting comprehensive reports on quality performance metrics to leadership and stakeholders. Communicating key finds and improvement plans to clinical teams and other relevant parties. Maintaining accurate documentation of QI activities and data analysis.
• Accreditation and Compliance: ensuring compliance with all applicable regulatory requirements related to HEDIS reporting and quality standards. Collaborating with quality team to manage multiple payer quality requirements.
• Training and Education: facilitates learning opportunities and knowledge-sharing sessions to promote awareness, understanding, and adoption of QI best practices. Provides training, education, and support to internal staff, healthcare providers, and network partners on quality improvement methodologies, performance measurement, and regulatory requirements.
• Develops department goals, objectives, policies and procedures. Ensures compliance with business unit policies and procedures and governmental accreditation regulations.
• Supervises and monitors the effectiveness of contracted vendors who assist with outreach, wellness, and quality efforts. Oversees the development of a Corrective Action Plan when goals are not met.
• Works collaboratively with cross-functional departments to develop reports to meet the department’s annual objectives. Uses technology to enhance decision-making and effectiveness.
• Oversees the development, implementation, and revision of wellness and preventative care programs, goals, and interventions. Ensures that each area meets targeted goals as determined by the regulatory jurisdiction.
• Identifies target populations, geographic areas, and key stakeholders to prioritize outreach efforts and maximize impact.
• Performs other duties as assigned.
Supervisory Responsibilities:
• Carries out supervisory responsibilities in accordance with the organization's policies and applicable laws.
• Responsibilities include interviewing, hiring, and training employees; planning, assigning, and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems.
Knowledge, Skills and Abilities
• Knowledge of current trends in health care delivery and population management.
• Knowledge of HEDIS, external audits and regulatory guidelines preferred.
• Strong analytical skills, technical writing skills, excellent problem-solving skills and ability to exercise independent judgment.
• Business acumen and leadership skills.
• Strong verbal and written communication skills with ability to effectively interact with all levels of management, internal departments and external agencies.
• Proficient with Microsoft Office applications, especially Word, Excel and PowerPoint.
• Ability to enter and retrieve information using a PC.
• Working knowledge of various computer software applications.
Minimum Education and Experience
• Bachelor's degree in healthcare field (BSN preferred)
• A minimum of 5 years of leadership experience managing Quality Ratings/HEDIS for a provider organization.
• Expertise in HEDIS, CAHPS and other common quality performance measures for ACO, MA, and Medicare quality programs.
• Strong clinical background to include clinical operations, strategy, and/or integrated delivery system
• 5 years of people management and supervisory experience – team management required.
• CPHCQ - Certified Professional in Healthcare Quality CPHQ certification highly desired
• Proficient in MS Office programs (i.e., Word, Excel, Outlook, Access, and Power Point). Moderate to Advanced excel skills to include charts, graphs, pivot tables, macros, etc.
• Bilingual: Spanish and English
