Director of Clinical Performance and Quality

Responsibilities Population Health Strategy & Quality Measurement Develops and executes comprehensive population health strategies aligned with TMPN's organizational goals, value-based care contracts, and payer partnerships. Leads performance improvement across all HEDIS measures, including preventive care screenings (BCS, COL, CCS), chronic disease management (CDC, CBP, SPC, SPD), and medication adherence (PDC) measures. Design and implement care gap closure initiatives, including systematic patient outreach campaigns, provider education, clinical workflow optimization, and point-of-care interventions. Drives CMS Star Rating performance through strategic planning, measure-level analysis, and cross-functional improvement efforts. Monitors CMS, NCQA, and other regulatory changes to quality measurement programs and adapt organizational strategies accordingly. HCC/RAF Management & Risk Adjustment Optimization Leads TMPN's Hierarchical Condition Category (HCC) capture and Risk Adjustment Factor (RAF) optimization programs across all Medicare Advantage and risk-based populations. Develops and executes annual HCC recapture strategies, including provider education on documentation specificity, condition recapture workflows, and coding accuracy initiatives. Oversees HCC coding auditing and monitoring programs to ensure accurate capture of patient acuity and clinical complexity in all encounters. Implements systematic processes for prospective and retrospective chart review, documentation improvement, and coding quality validation. Monitors CMS risk adjustment methodology changes (V24/V28 model transitions) and adjust organizational strategies proactively. Data Analytics & Reporting Builds and oversees TMPN's population health data and analytics infrastructure, including dashboards, performance reports, and predictive analytics capabilities. Develops provider-level, clinic-level, and network-level performance scorecards that track quality measures, HCC capture rates, RAF scores, and care gap closure metrics. Leverage data from EMR systems (Epic/Cerner), health plan portals, claims data, and other sources to identify trends, forecast performance, and drive decision-making. Designs and executes risk stratification models to identify high-risk patients for targeted interventions, care management referrals, and proactive outreach. Leadership & Stakeholder Engagement Directly manages and develops a team of managers and analysts across population health, HCC/RAF, and data analytics functions. Presents population health performance, strategic recommendations, and operational updates to senior leadership, medical staff committees, and health plan partners. Serves as a key liaison between TMPN operations and physician leadership on quality performance, risk adjustment, and population health initiatives. Manages departmental budgets, vendor relationships, and resource allocation to maximize return on population health investments. Requirements Education & Experience Bachelor’s degree in Healthcare Administration, Public Health, Health Informatics, Business Administration, or related field required. Master's degree in Business Administration (MBA), Public Health (MPH) or Health Administration (MHA), strongly preferred. Minimum of seven (7) years of progressive experience in population health management, healthcare quality, or value-based care operations. Minimum of five (5) years in a leadership role and management of a team or personnel. Demonstrates expertise in HEDIS measures, CMS Star Ratings, and value-based care quality programs. Experience in HCC/RAF optimization, risk adjustment strategy, and coding compliance Experience with healthcare data analytics, performance reporting, and population health technology platforms. Experience in physician practice, ambulatory care, or medical group management setting strongly preferred. Technical Skills & Knowledge Strong understanding of CMS quality programs, NCQA HEDIS specifications, Star Ratings methodology, and value-based care contract structures. Expert knowledge of HCC coding, CMS-HCC risk adjustment models (V24/V28), RAF score calculation, and RADV compliance requirements. Strong proficiency with healthcare analytics tools, EMR reporting modules (Epic/Cerner), and business intelligence platforms. Experience with SQL, data visualization tools, or health analytics platforms for population-level reporting. Communication & Leadership Excellent written and verbal communication skills with ability to present complex data and clinical quality concepts to diverse audiences including executive leadership, physicians, and frontline staff. Strong relationship-building skills with physicians, health plan partners, and cross-functional operational teams. Proven ability to influence clinical practice through education, data-driven recommendations, and collaborative problem-solving. Experience in building, developing, and retaining high-performing teams in healthcare operations. Preferred Qualifications Experience with Lean/Six Sigma methodology in healthcare quality improvement (certification a plus). Experience in managing population health programs for Medicare Advantage populations of 10,000+ members. Strong background in predictive modeling and advanced analytics for patient risk stratification Familiarity with behavioral science approaches patient outreach and engagement. Salary Range: $142,438.00 - $247,728.00 per year #J-18808-Ljbffr