Director, Quality Improvement

Location: Orange, California US

Notice

This position is no longer open.

Job Number: 1368

Workplace Type:

Position Title: Director, Quality Improvement

External Description:

The Director of the STAR Program is responsible for leading and driving all aspects of the Alignment STAR program by ensuring all enterprise leaders and their teams are involved and highly engaged in the improving the overall STAR program.  This position will be responsible for the strategy and implementation of all aspects of the program – HEDIS, CAHPS, HOS, Part C and Part D administrative measures – and for overseeing all activities and interventions related to process and workflow, data collection, data analytics and evaluation, IPA engagement, member touchpoints, etc.  The Director of the STAR Program must maintain current knowledge of all requirements of the CMS STAR Rating Program and is responsible for identifying, creating, leading, tracking, reporting and managing initiatives related to improving the STAR Rating and ensuring that corporate STAR objectives are met. The candidate is tasked with leading and overseeing the work of cross-departmental focused initiatives to increase and/or maximize quality ratings through both long and short term strategies.  This Director must be able to collaborate with peers and motivate other staff to execute the STAR Program plan and provide clear status on all elements of the program in detail to the project team and the executive team.    

 

General duties & responsibilities: (there are additions)

 

  • Establish strategic vision with senior management for STARS improvement in accordance with Alignment Healthcare business planning process.
  • Develop strategies and implement tactical plans to improve HEDIS, CAHPS, HOS, and other Stars related measures
  • Work with cross-functional teams (XFT) to ensure integration and advantaging XFT opportunities (e.g. Vendor contracting and unit cost on chart pulls, combining provider incentives, etc.)
  • Drive weekly results with regards to STARS related measurements.
  • Drive operational excellence into all process’s including provider interactions and member interactions form STAR program structure.
  • Ability to develop executive sponsorship for changes required in STARS or operational effectiveness.
  • Manage department budget including staffing projections and expenditures.
  • Establish a positive working environment that promotes staff retention and satisfaction and results in provider/customer satisfaction.
  • Lead selection standards and process for insuring quality selection and retention of department employees.
  • Other Duties as Assigned

 

 

Supervisory Responsibilities:

Oversees assigned staff. Responsibilities include: recruiting, selecting, orienting, and training employees; assigning workload; planning, monitoring, and appraising job results; and coaching, counseling, and disciplining employees.

 

Minimum Requirements:

  • Bachelor’s degree or equivalent work experience (5 years) background in insurance or managed care preferably in a project management or quality improvement department.  Master’s preferred (MPH, MBA, MHA).
  • 3 years’ experience with STARS and/or clinical metric management preferred Director STAR Program level.
  • Ability to work with the Executive team in providing a comprehensive multi-year plan and budget and providing subsequent monthly executive status on the program.
  •     Delivery of comprehensive dashboard status for all elements of the program with key initiatives and analytics (e.g. Numerator/Denominator and score tied to STAR rating by measure).
  • Proven problem solving skills and ability to translate knowledge to various departments involved in the STARS program.
  • Ability to create and implement actionable plans to improve STARS scores or operational processes through use of data analysis
  • Demonstrated track record of generating results and having an impact on organizations.
  • Demonstrated forward thinking in areas of technology support, project management and leadership.
  • Strong leadership skills with the ability to develop teams.
  • Innovative in problem solving, planning and strategizing.
  • Articulate & persuasive in presenting business-case for change-management, where required.

 

Essential Physical Functions:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

 

  • While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.
  • The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.

City: Orange

State: California

Location City: Orange

Location State: California

Community / Marketing Title: Director, Quality Improvement

Company Profile:

By leveraging our world-class technology platform, innovative care delivery models, deep physician partnerships and our serving heart culture, Alignment Health is revolutionizing health care for seniors! From member experience professionals and clinicians, to data scientists and operations leaders, we have built a talented and passionate team that is deeply committed to our mission of transforming health care for the seniors we serve. Ready to join us?

At Alignment, delivering exceptional care to seniors starts with ensuring an exceptional experience for our over 1,300 employees. At the center of our employee experience is a culture where employees at all levels and across all teams are encouraged to share their unique ideas and perspectives. After all, when you can bring your authentic self to work, whether that’s in a clinical setting, our corporate office or a home office, creativity and innovation flourish! Another important part of the Alignment culture is a belief in continuous learning and growth. As a result, in this fast-growing company, you will find ample support to grow your skills and your career – with us.

EEO Employer Verbiage:

 

Please note: All clinical positions are contingent upon successful engagement with Alignment Health’s COVID-19 Vaccination program (fully vaccinated with documented proof or approved exception/deferral).

Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.

*DISCLAIMER: Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Please be advised that Alignment Health and its subsidiaries will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at https://reportfraud.ftc.gov/#/. If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health’s talent acquisition team, please email [email protected].