What are the responsibilities and job description for the Director, Quality Programs - Michigan position at McLaren Health Care?
We are looking for a Director, Quality Programs, to join us in leading our organization forward.
McLaren Integrated HMO Group (MIG) is a fully owned subsidiary of McLaren Health Care Corporation and is the parent company of McLaren Health Plan in Michigan and MDwise, Inc. in Indiana. It is an organization with a culture of high performance and a mission to help people live healthier and more satisfying lives.
McLaren Health Plan and MDwise, Inc., subsidiaries of MIG, value the talents and abilities of all our employees and seeks to foster an open, cooperative and dynamic environment in which employees and the health plans can thrive. As an employee of MIG, you will be a part of a dynamic organization that considers all our employees as leaders in driving the organization forward and delivering quality service to all our members.
McLaren Health Plan is our Michigan-based health plan dedicated to meeting the health care needs of each of our Michigan members. Learn more about McLaren Health Plan at https://www.mclarenhealthplan.org .
MDwise is our Indiana-based health plan, working with the State of Indiana and Centers for Medicare and Medicaid Services to bring you the Hoosier Healthwise and Healthy Indiana Plan health insurance programs. Learn more about MDwise, Inc. at https://www.mdwise.org/ .
Position Overview:
The Director of Quality Programs is responsible for developing, implementing, and leading quality program strategies, policies, and best practices for McLaren Health Plan (MHP) across the Michigan lines of business. This role provides leadership and strategic direction including planning, organizing, directing, evaluating, and optimizing all quality initiatives and outcomes. Responsibilities include but are not limited to development and execution of the Quality Performance Improvement Plan (QPIP); HEDIS, CAHPS, and Stars performance; strategic planning; regulatory representation, reporting, and communication; pay-for-performance programs; and quality improvement initiatives that maximize member outcomes and provider engagement. The Director works across the organization to ensure an integrated approach to clinical, operational, and analytical functions to achieve optimal quality performance and compliance with state, federal, and accreditation standards.
This is a hybrid position with requirements to come onsite as scheduled, Flint, MI.
QUALIFICATIONS: Required:
McLaren Integrated HMO Group (MIG) is a fully owned subsidiary of McLaren Health Care Corporation and is the parent company of McLaren Health Plan in Michigan and MDwise, Inc. in Indiana. It is an organization with a culture of high performance and a mission to help people live healthier and more satisfying lives.
McLaren Health Plan and MDwise, Inc., subsidiaries of MIG, value the talents and abilities of all our employees and seeks to foster an open, cooperative and dynamic environment in which employees and the health plans can thrive. As an employee of MIG, you will be a part of a dynamic organization that considers all our employees as leaders in driving the organization forward and delivering quality service to all our members.
McLaren Health Plan is our Michigan-based health plan dedicated to meeting the health care needs of each of our Michigan members. Learn more about McLaren Health Plan at https://www.mclarenhealthplan.org .
MDwise is our Indiana-based health plan, working with the State of Indiana and Centers for Medicare and Medicaid Services to bring you the Hoosier Healthwise and Healthy Indiana Plan health insurance programs. Learn more about MDwise, Inc. at https://www.mdwise.org/ .
Position Overview:
The Director of Quality Programs is responsible for developing, implementing, and leading quality program strategies, policies, and best practices for McLaren Health Plan (MHP) across the Michigan lines of business. This role provides leadership and strategic direction including planning, organizing, directing, evaluating, and optimizing all quality initiatives and outcomes. Responsibilities include but are not limited to development and execution of the Quality Performance Improvement Plan (QPIP); HEDIS, CAHPS, and Stars performance; strategic planning; regulatory representation, reporting, and communication; pay-for-performance programs; and quality improvement initiatives that maximize member outcomes and provider engagement. The Director works across the organization to ensure an integrated approach to clinical, operational, and analytical functions to achieve optimal quality performance and compliance with state, federal, and accreditation standards.
This is a hybrid position with requirements to come onsite as scheduled, Flint, MI.
QUALIFICATIONS: Required:
- Bachelor’s degree in nursing, health care, or related field.
- Valid unrestricted RN License; or certified professional in health care quality.
- Five (5) years’ experience in a progressively more responsible leadership role with experience and knowledge of Managed Care functions with at least three (3) years’ experience in a management role leading or assisting in all phases of effective supervision.
- Five (5) years in health plan quality management operations.
- Five (5) years’ experience in a senior HMO leadership position with experience and knowledge of HMO, PPO, TPA, PHO and Managed Care functions.
- Schedule: Full-time
- Requisition ID: 25006810
- Daily Work Times: 8:30 am - 5:00 pm
- Hours Per Pay Period: 80
- On Call: No
- Weekends: No
