Sr Director, Quality Ratings & Network Performance

Morgan Consulting Resources, Inc. has been retained by Community Health Plan of Washington to conduct the search for a Senior Director, Quality Ratings and Network Performance . This is a remote position with quarterly travel to the home office in Seattle. About Community Health Plan of Washington For nearly 30 years, Community Health Plan of Washington (CHPW) has been providing quality health care to Washington families and supporting their choices for health care. CHPW’s coverage is geared toward a model of care that treats the whole person and fosters trust, compassion, respect, and equality. Mission: “Our mission is to deliver accessible managed care services that meet the needs and improve the health of our communities, and make managed care participation beneficial for community-responsive providers. We work for patients, and we work to help providers better serve those patients.” Learn more about the organization at About the Senior Director, Quality Ratings and Network Performance The Senior Director, Quality Ratings and Network Performance (“Senior Director”) leads strategic initiatives to improve health plan quality ratings and provider performance, with a focus on Medicaid, Exchange, and D-SNP populations. This role is responsible for collaborating across the organization with other key stakeholders and leaders to drive measurable improvements in official HEDIS, HOS, STAR and CAHPS performance and reporting, as well as execution of provider strategies to drive measurable improvement, while ensuring compliance with state and federal regulatory requirements. Key to success in this role includes bringing a deep expertise in Medicaid and Medicare quality programs, analytic approaches to conducting comprehensive evaluations and outcome measurement of rapid cycle improvement strategies, HEDIS, CAHPS and HOS program management and strategic approaches to optimizing data procurement and reporting, D-SNP Star program management, and value-based provider strategies. Key Functions Quality Ratings Oversight Organization Star Program Management Provider Network Performance Leadership & Collaboration Knowledge, Skills & Abilities Experience with state Medicaid programs and CMS Star Program. Ability to translate data into actionable insights for diverse stakeholders. Knowledge of HEDIS, CAHPS, HOS, and Stars requirements and their impact on the organization. Independent and complex problem-solving skills including the ability to assist others in working through complex problems to meet desired outcomes. Analytical skills and the ability to interpret, evaluate and formulate action plans based upon data. Verbal and written communication skills, including the ability to present in front of a variety of audiences. Ability to set performance expectations, coach for performance success, and achieve department and company objectives. Ability to add insight and value to corporate initiatives, including program evaluation and innovation. Required Qualifications Bachelor’s degree in healthcare administration, public health, nursing, healthcare economics, or related field, a Master’s degree is highly preferred. Ten (10)+ years of experience in healthcare quality, performance improvement, or healthcare analytics, with a focus on Medicare D-SNP, Medicaid, and Exchange. Minimum of seven (7) years of progressive leadership experience. Deep knowledge of CMS Stars, HEDIS, CAHPS, HOS and Medicaid-specific quality programs. Proven leadership in managing cross-functional teams and complex initiatives. Highly skilled in analytics, communication, and strategic planning. About CHPW’s Culture “Our Mission is our North Star, an overarching purpose carried out through our strategic goals. Our Values, orient us toward them; they influence our behaviors, actions, and priorities. Values by their nature are aspirational and serve as core principles. They give us a sense of purpose and direction, setting the tone for our daily interactions with each other. We are committed to the ongoing process of making our values a lived reality by infusing them into all aspects of how we lead and work together. Our shared values include: We Center Our Communities: We support the communities we serve, our colleagues, and those we partner with, by giving each person what they need to thrive. We Aim Towards Justice: We champion inclusive behaviors to help build bridges across our differences in the pursuit of building fair systems and practices. We Build Trusting Relationships: We embrace collaboration by inviting in more voices, and actively listening to them, to improve our teamwork and achieve our goals. We Own Our Actions: We strive to do the right thing by holding ourselves accountable to the communities we serve, to each other, and to ourselves. Compensation and Benefits The expected base pay range is $180,000-$210,000 with a 15% annual incentive target based on company, department, and individual performance goals. Explore CHPW’s full benefits at If you or someone you know brings expertise in Medicare Stars and has worked with provider networks to drive quality improvement, this may be a great fit! Erica Eikelboom, Principal & Executive Search Consultant View email address on click.appcast.io Additional Information Reports to: Senior VP, Health Services Essential functions and Roles and Responsibilities Quality Ratings Oversight Lead strategy and execution for Health Plan ratings strategies (e.g., NCQA, VBP, P4P, EQRO) and D-SNP Stars ratings. Lead data collection and validation for official HEDIS, CAHPS and HOS reporting to regulatory bodies. Monitor and analyze performance across HEDIS, CAHPS, and other key health plan rating measures; collaborate with Quality/Population Health leaders to develop and execute targeted improvement plans. Collaborate with internal teams to ensure accurate and timely data submission to CMS and state agencies. Facilitate and/or oversee the organization’s cross-functional Star Improvement Committee, as well as cross-departmental collaborative meetings focused on Health Plan rating measure strategies. Manage vendor contracts and provide vendor oversight, including monitoring key performance indicators and ensuring adherence to contract terms to support Star and/or quality programs. Provider Network Performance Develop and implement provider engagement strategies to improve quality outcomes for Medicaid, Exchange and D-SNP members. Partner with network management, clinical operations, and analytics to identify performance gaps and drive improvement. Lead clinic partnerships and data integration team to effectively deploy practice transformation and quality coaching models with the CHC network. Oversee strategies to leverage provider-facing tools, dashboards, and education to support quality and compliance goals. Leadership & Collaboration Lead a cohesive and motivated team of professionals and analysts focused on employing continuous quality improvement techniques leveraging data effectively to support rapid cycle improvements in performance. Serve as a strategic advisor to executive leadership on quality trends, risks, and opportunities. Foster a culture of accountability, innovation, and continuous improvement. Collaborate with leaders in Clinical Services and across the organization to identify and facilitate improvement projects to enhance organizational performance on quality measures. Lead and collaborate with internal and external stakeholders to ensure Stars, CAHPS/HOS and other quality measurement initiatives are fully integrated throughout the organization, maximizing opportunity to improve outcomes for members. Set and manage department budget, as applicable. Other duties as assigned. Essential functions listed are not necessarily exhaustive and may be revised by the employer, at its sole discretion. #J-18808-Ljbffr