Senior Director, Quality Ratings & Network Performance

Job Description

Job Description

Presented by Morgan Consulting Resources. Please follow this link to apply to this position.

Who we are

Community Health Plan of Washington is an equal opportunity employer committed to a diverse and inclusive workforce. All qualified applicants will receive consideration for employment without regard to any actual or perceived protected characteristic or other unlawful consideration.

Our commitment is to:

• Strive to apply an equity lens to all our work.
• Reduce health disparities.
• Create an equitable work environment.

About the Role

The Senior Director, Quality Ratings and Network Performance 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, 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.

To be successful in this role, you:

• Possess a Bachelor’s degree in healthcare administration, public health, nursing, healthcare economics, or related field, a Master’s degree is highly preferred.
• Have ten (10) + years of experience in healthcare quality, performance improvement, or healthcare analytics, with a focus on Medicaid, Exchange and/or D-SNP.
• Have a minimum of seven (7) years of progressive leadership experience.
• Possess a deep knowledge of CMS Stars, HEDIS, CAHPS, HOS and Medicaid-specific quality programs.
• Have proven leadership in managing cross-functional teams and complex initiatives.
• Are highly skilled in analytics, communication, and strategic planning.

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.

Knowledge, Skills, and Abilities:

• Experience with state Medicaid programs and CMS D-SNP regulations.
• 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.

As part of our hiring process, the following criteria must be met:

• Complete and successfully pass a criminal background check.

Criminal History: includes review of criminal convictions and probation. CHPW does not automatically or categorically exclude persons with a criminal background from employment. The applicant’s criminal history will be reviewed on a case-by-case basis considering the risk to the business, members, and/employees.

• Has not been sanctioned or excluded from participation in federal or state healthcare programs by a federal or state law enforcement, regulatory, or licensing agency.
• Candidates whose disabilities make them unable to meet these requirements are considered fully qualified if they can perform the essential functions of the job with reasonable accommodation.

Compensation and Benefits:

The position is FLSA Exempt and is not eligible for overtime. Based on market data, this position grade is 74 and has a 15% annual incentive target based on company, department, and individual performance goals. The targeted annual salary range is between $180,000.00 - $210,000.00.

CHPW offers the following benefits for Full and Part-time employees and their dependents:

• Medical, Prescription, Dental, and Vision
• Telehealth app
• Flexible Spending Accounts, Health Savings Accounts
• Basic Life AD&D, Short and Long-Term Disability
• Voluntary Life, Critical Care, and Long-Term Care Insurance
• 401(k) Retirement and generous employer match
• Employee Assistance Program and Mental Fitness app
• Financial Coaching, Identity Theft Protection
• Time off including PTO accrual starting at 17 days per year.
• 40 hours Community Service volunteer time
• 10 standard holidays, 2 floating holidays
• Compassion time off, jury duty pay.

Sensory/Physical/Mental Requirements:

Sensory* :

• Speaking, hearing, near vision, far vision, depth perception, peripheral vision, touch, smell, and balance.

Physical* :

• Extended periods of sitting, computer use, talking and possibly standing.
• Simple grasp, firm grasp, fine manipulation, pinch, finger dexterity, supination/pronation, wrist flexion.
• Frequent torso/back static position; occasional stooping, bending, and twisting.
• Some kneeling, pushing, pulling, lifting, and carrying (not over 25 pounds), twisting, and reaching.

Mental :

• Must have the ability to learn and prioritize multiple tasks within the scope and guidelines of the position and its applicable licensure requirements, many requiring extremely complex cognitive capabilities. Must be able to manage conflict, communicate effectively and meet time-sensitive deadlines.

Work Environment:

Office environment Employees who frequently work in front of computer monitors are at risk for environmental exposure to low-grade radiation.

*Candidates whose disabilities make them unable to meet these requirements are considered fully qualified if they can perform the essential functions of the job with reasonable accommodation.

*The above is intended to describe the general content of and the requirements for satisfactory performance in this position. It is not to be construed as an exhaustive statement of the duties, responsibilities, or requirements of this position. Job descriptions may be updated or changed to reflect business needs.