Overview
Oversees and leads the development, implementation and strategic oversight of VNS Health Plan's Quality programs and improvement initiatives to ensure the highest standards of care and service for our members. Leads strategic initiatives aimed at optimizing clinical quality, enhancing member satisfaction, and achieving high Medicare Star ratings. Oversees the performance of Health Plans Quality Programs, emphasizing continuous quality improvement and member satisfaction.
Compensation:
$216,900.00 - $289,200.00 Annual
What We Provide
- Referral bonus opportunities
- Generous paid time off (PTO), starting at 30 days of paid time off and 9 company holidays
- Health insurance plan for you and your loved ones, Medical, Dental, Vision, Life Disability
- Employer-matched retirement saving funds
- Personal and financial wellness programs
- Pre-tax flexible spending accounts (FSAs) for healthcare and dependent care
- Generous tuition reimbursement for qualifying degrees
- Opportunities for professional growth and career advancement
- Internal mobility, generous tuition reimbursement, CEU credits, and advancement opportunities
What You Will Do
- Develops and implements comprehensive strategic plan for Health Plans Quality Programs in alignment with VNS Health mission and objectives. Provides leadership, oversight, and guidance to maintain the highest levels of clinical quality and member experience across all Health Plan products.
- Monitors and analyzes Medicare Stars and quality performance metrics and identifies areas for improvement.
- Oversees performance of Health Plans Quality Programs based on continuous improvement practices.
- Identifies and evaluates data needs, trends and target quality and satisfaction measures that require improvement. Develops and ensures consistent, reliable and valid application of data collection and analysis for priority performance improvement measures.
- Leads cross-functional initiatives between VNS Health departments including but not limited to Care Management, Call Center, Pharmacy Services, Provider Network to ensure alignment with quality objectives and regulatory requirements.
- Maintains relationships with external vendors and provides ongoing support to manage initiatives that impact quality and member experience. Ensures that all improvement actions are evaluated for effectiveness.
- Utilizes member feedback and data analytics to identify trends and opportunities to improve member satisfaction and member experience.
- Fosters a culture of member-centricity throughout the Health Plans ensuring that member needs and expectations are met or exceeded.
- Develops and maintains an expert level of knowledge of Medicare Stars and New York State quality programs. Keeps up to date on program changes.
- Monitors New York State and CMS regulations related to quality programs and other guidance that impacts quality measures.
- Oversees the Education & Development program to ensure Health Plans team members training needs are met.
- Champions a culture of continuous improvement, encouraging innovation and efficiency in processes.
- Develops and maintains collaborative relationships with Compliance, Government Affairs, and regulatory agencies to ensure that all protocols and procedures are consistent with regulatory requirements.
- Maintains all policies and procedures according to regulatory requirements and industry best practices.
- Manages budget and control expenses while meeting goals and objectives.
- Participates in special projects and performs other duties as assigned.
Qualifications
Education:
- Bachelor's Degree in nursing, health care, or equivalent work experience required
- Master's Degree in nursing, health care, or equivalent work experience preferred
Work Experience:
- Minimum of eight (8) years of progressive leadership in quality improvement with specific managed care experience with (5) years of progressive managerial experience in healthcare required
- Extensive knowledge of managed care regulations and quality standards and improvement methodologies required
- Proven track record of leading successful quality improvement initiatives and improving performance metrics required
- Demonstrated working knowledge of Medicare Stars and New York State Quality Incentive Programs required
- Knowledge of health care delivery systems, clinical quality assessments, and data analysis techniques required
- Strong analytical and problem-solving skills with the ability to interpret complex data and translate it into actionable insights with a data-driven approach to decision-making required
- Excellent oral/written communication and presentation skills required
- Demonstrated ability to lead and motivate a diverse team of professionals required
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