Sr. Director, Quality Performance - Boston, MA, United States - Commonwealth Care Alliance

Description

Under the direction of, and in close collaboration with, the Vice President, Population Health & Network Quality, the Senior Director, Quality Performance and Value Based Care is responsible for leading the development and maintenance of quality performance programs, as well the development and analysis of performance measures related to value based care. This role will also develop initiatives focused on the growth of value-based care strategies across CCA markets. The Senior Director works closely with other enterprise leaders to drive performance in markets, building on demonstrated success in high quality health care services for complex populations.

The Senior Director leads and supervises multiple teams responsible for providing recommendations on alternative payment models, contract language, evidence based and national benchmark measures and practice management and support to improve quality performance and member health outcomes. This role works directly with other clinical, network contracting, provider engagement and operational leaders to develop and optimize quality performance metrics to positively impact CCA's value based care strategies. The Senior Director is a member of CCA's quality improvement leadership team and participates in key planning and ongoing development activities required of leaders across the organization.

Supervision Exercised: Yes

Collaborates with the CCA Quality Leadership Team to ensure comprehensive attainment of CCA Quality Performance goals.

In collaboration with Quality leadership and staff, directs and oversees enterprise-wide efforts to ensure that CCA Quality Programs meet or exceed the performance standards and requirements of federal and state regulators, and other external accreditation agencies e.g. CMS Stars and Mass State Withhold measures).

Develops and maintains core CCA Quality Program documentation for all markets and products, including: the CCA Alternative Payment Model/Value Based Care strategy (APM/VBC); Performance Incentive Payment contract amendments, Provider Manual documentation on APMVBC program. These key documents are created in consideration of our performance in publicly reported measures and align with the clinical and quality strategy and HEDIS, CAHPS, HOS measures.

Establishes quantitative and qualitative metrics, guidelines, and standards by which provider and facility network's efficiency and effectiveness can be evaluated identifies opportunities for improvement and implements gap closures.

Develops operating standards and controls to ensure contractual and regulatory compliance of CCA's operations processes and programs

Collaborates with CCA's Regulatory Affairs and Compliance division to maintain oversight of contractual and regulatory compliance of clinical operations processes and programs

Facilitates high quality, accurate, contractual and regulatory reporting for quality improvement processes and programs

Develops creative solutions to address a wide variety of unique market problems and opportunities

Works closely with other enterprise leaders to drive performance in markets, building on demonstrated success in high quality health care services for complex populations.

Identifies opportunities to streamline workflows that result in accurate, high quality productivity standards and improved results in cost savings, or outcomes measurement.

Coordinates with accreditation leads to address VBC Population Health standards, to ensure integration of workflows and standardization of NCQA program requirements are demonstrated and reported on.

Maintains knowledge of regulatory responsibilities as documented in State Medicaid and Medicare contracts and Medicare managed care manual and work with quality and clinical leaders to meet and exceed requirements.

Leads planning and implementation of annual adjudication of the VBC program, evaluation of its effectiveness and annual workplan inclusive of building new capabilities which may include adherence to compliance regulations, process development, system implementations, analytics capabilities, and/or reporting in collaboration with QI analytics team.

Works with CCA leadership to enact CCA's mission, vision, and growth strategy as relates to quality improvement, revenue optimization and member outcomes.

Facilitate and/or participate in continuous improvement and business process optimization

Required Education:

Bachelor's Degree in Public Health, Health Administration, or other relevant field

Desired Education:

Master's degree in health care administration or related field

Desired Licensing:

CPHQ or PMP (preferred)

Required Experience:

7 years managing a team of business or statistical analysts required

7 years' experience leading complex operation and process improvement,

5+ years of analytical experience with data or statistical analysis in healthcare industry/health informatics team required

Leadership experience in both health plan and provider organization settings preferred

Solid organizational skills and ability to balance multiple priorities in a dynamic environment; ability to drive process improvements

Strong financial planning experience required, including preparation of complex annual and long-term budgets

In-depth knowledge of Medicare Advantage, Managed Medicaid lines of business

Experience with Medicare or Medicaid health care regulatory reporting and compliance activities

Desired Experience:

Expert knowledge of public payer health care programs (Medicare, Medicaid)

Expert knowledge of provider reimbursement strategies, in-depth understanding of value based models

Required Knowledge, Skills & Abilities:

Proficiency in interpreting results and formulating recommendations/action plans

Demonstrated ability to work independently

Ability to research and analyze state/federal regulations related to health insurance and healthcare

Demonstrated skills in analytical reasoning and interpretation and evaluation of complex information

Ability to work productively in a matrix organization, accessing the right input from the right people at the right time

Ability to operate at both a strategic level to align business owners on priorities as well as at a tactical level to lean in and drive the necessary cross-company collaboration for effective end-to-end execution.

Proven experience developing strong teams and building effective operating models to drive results.

Proven ability to assess, retain, grow, and attract strong diverse talent to meet business objectives

Strategic, system focused thinking and strong change management skills

Strong facilitation and leadership skills to drive consensus and manage successful teams

Able to integrate new ideas, synthesize large amounts of data, draw conclusions into actionable approaches, and clearly communicate key findings to a wide range of audiences

Able to organize information and effectively present specific content tailored to different audience needs

Excellent program management skills with proven track record of managing complex and cross-functional initiatives

Ability to prioritize competing opportunities, resolve issues efficiently and effectively, and refine strategies

Excellent interpersonal skills and effective relationship building skills with both internal and external partners

Excellent leadership skills to guide, inspire and develop a high performing team of professionals

Languages: English