Director, Quality\/HEDIS
Humana

Job Info

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Description

The Director, Quality Audit (Stars HEDIS Improvement and Operations), leads the advancement of initiative improvement strategy, operational execution and performance oversight in effort to maintain CenterWell's strong HEDIS Stars results. The individual will lead the team in defining improvement objectives focused on clinical gap closure, health outcomes and improved member experience.

Responsibilities

The Director, STARS Improvement develops programs designed to increase the plan quality. Partners with leaders regarding implementation planning. Reviews and communicates results of programs. Decisions are typically related to the implementation of new/updated programs or large-scale projects for the function and supporting technical/operational procedures and processes, and implements strategic plans, drives goals and objectives, and improves performance. Provides input into functions strategy.

Role responsibilities:

• Have a deep understanding of HEDIS Stars measures
• Focus on improvement initiatives directed on delivering improved performance rates and optimal customer experiences
• Lead a quality team that spans multiple states and health plan payors
• Create collaborative working relationships with partners across the organization in effort to create shared learning agendas and goals
• Oversee performance oversight and roadmap toward operational excellence for Stars HEDIS operational areas such as: Test Kit Program operations, Stars Outreach team, and HEDIS process improvement
• Must be able to take complex problems and distill into manageable pieces to develop solutions
• Responsible for performance monitoring and operational reporting, with regular executive summary roll-up to leadership developing robust reporting informing prioritized opportunities for Quality improvement and experience
• Lead monthly meeting with quality consultants and local market to ensure identification of opportunities and best practices for improvement
• Remains current and informed about Stars/HEDIS, NCQA and CMS industry trends
• Represent Hedis/Stars initiatives during quarterly operations meetings with health plan payors
• Monitor and reconcile metric outages between CenterWell and health plan payors.

Required Qualifications

• Bachelor's Degree or 5 years equivalent
• 5 or more years of management experience
• RN or Health Care Administrator preferred
• Progressive experience in the health solutions industry, with emphasis on leading and managing teams
• Prior Medicare/Medicaid experience
• Prior managed care experience
• Proficiency in analyzing and interpreting healthcare data and trends
• Strong attention to detail and focus on process and quality
• Excellent communication skills
• Ability to operate under tight deadlines
• Comprehensive knowledge of all Microsoft Office applications, including Word, Excel and PowerPoint
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Preferred Qualifications

• Master's Degree in Business Administration, Health Administration or a related field
• Proven organizational and prioritization skills and ability to collaborate with multiple departments
• Knowledge of HEDIS/Stars and CMS quality measures
• PMP certification a plus
• Six Sigma Certification also a plus

Additional Information

• Previous operational management leadership experience
• Proven skills in analyzing data trends and identifying performance improvement opportunities
• Strong attention to detail and focus on customer experience and quality
• Excellent communication skills
• Ability to operate under tight deadlines
• Comprehensive knowledge of all Microsoft Office applications, including Word, Excel and PowerPoint
• Ability to travel as determined by business needs

Scheduled Weekly Hours

40

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