VP of Quality _ RN_MD

Tarrytown, NY

Type: Full Time

Eve Crane & Associates Inc.

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				VP, Quality


Schenectady, New York

Tarrytown, New York with some travel

The VP Quality provides strategic leadership and operational oversight for the full range of activities to achieve and maintain the quality and performance goals of COMPANY Health Care. This includes developing and implementing an effective and comprehensive strategy to assure HEDIS/QARR/STARS and CAHPS continuous improvement and the highest level of performance. STARs and QARR performance have a significant revenue implication for Company as well as a significant impact on membership especially in the Individual markets including Medicare Advantage and Medicaid. This position is responsible for achieving the revenue and membership goals associated with Quality performance. Leads the development and oversight of activities to assure compliance with all state and federal regulatory and accreditation requirements. Leads the operational functions and innovations around the overall quality improvement plan. Serves as the business leader for HEDIS for all Lines of Business. Serves as the lead for facilitating Quality functions related to QARR in conjunction with the Medicaid SBU. Serves as the lead for facilitating Quality functions related to CMS STARS in conjunction with the Medicare SBU. Oversees the development of a comprehensive strategy for measure improvement, including action plans for key measures that include metrics and reporting. Serves as business lead for NCQA accreditation, including oversight of accreditation standards and surveys. Maintains oversight of QI Analytics functions regardless of what department generates them. Develops effective working relationships and efficient cross functional processes and integration of COMPANY quality improvement activities with Medical Affairs, IT, Finance, Customer Call Center, Informatics, Network Transformation, Professional Relations, and strategic business units. Working with leadership in those departments, assures that COMPANY programs meet or exceed regulatory and accreditation standards and continually strive to bring the best health care and service to COMPANY members. Serves as liaison between internal and external cross functional teams and vendors. Provides leadership and education for reporting processes, data utilization, data interpretation and decision support related to all of the above. Actively participates in Data Governance team and other COMPANY Committees and Work Groups as assigned. Provides oversight for effective external interfaces with providers (gaps in care reports and pay for performance programs, etc.). Oversees functions related to data abstraction, including developing efficiencies in that process. Responsible for QI department budget preparation and monitoring. Responsible for development and maintenance of policies, procedures, manuals and training programs as they relate to Quality. Supervises staff including selection, orientation, training, performance management, counseling, and corrective action as needed. Handles policy and employee issues in conjunction with Human Resources. Perform other duties as assigned. 
Minimum Education:   RN or MD required. Current professional clinical license in New York State or qualified to obtain. MBA, MPh or similar degree preferred 
Minimum Experience: 5-10 year management experience, at least 5 years in healthcare quality improvement and 5 years in health plan management required .  Previous experience in Medicaid managed care quality programs preferred.  Ability to maintain confidentiality and adhere to regulatory compliance requirements 
Required Skills: 
* Knowledge of HEDIS/QARR/STARS and NCQA 
* Data abstraction and clinical reporting experience in a managed care environment 
* Strong communication and interpersonal skills 
* Ability to multi-task, manage multiple projects at once and prioritize 
* Ability to lead by influence across the internal and external stakeholders who are critical to success in Quality
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