Director of Quality II

Baltimore, MD

Type: Full Time

Eve Crane & Associates Inc.

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				Responsible for developing, coordinating, communicating, and implementing a strategic clinical quality management and improvement program within assigned health plan. Primary duties may include, but are not limited to:
 
*         Promotes broad understanding, communication, and collaboration with enterprise-wide leaders to ensure appropriate communication, integration, and utilization of quality best practices across all healthplan activities.
*         Oversees and designs (as appropriate) internal and state Quality Management (QM) Scorecard reporting.
*         Develops key relationships in community, with providers and with city, state and government agencies to maximize impact of the healthplan's quality program
*         Uses advanced technical data, EMR Systems and other electronic health information to drive strategic planning for the quality department 
*         Oversees Health Employer Data Information Sets (HEDIS) reporting and designs action plans to achieve target improvement goals. 
*         Provides leadership for QM representation in new business activities.
*         Ensure compliance with and drives improved healthplan performance in National Committee for Quality Assurance (NCQA) standards or other accrediting bodies.
*         Supports the External Quality Review Organization (EQRO) reporting and state audit processes.
* Hires, trains, coaches, counsels, and evaluates performance of direct reports. 
Requires a BA/BS in a health or business-related field; 
10 years of experience in a healthcare environment, including prior management experience; or any combination of education and experience, which would provide an equivalent background. MSN, MPH, or MPA preferred. 
CQM experience in a Managed Care Organization strongly preferred. 
Population health management and/or clinical quality program development experience preferred.
			
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