Director of Health Plan Quality & Member Experience – Medicare - Pearland, TX
About The Position
Explore opportunities with Kelsey-Seybold Clinic, part of the Optum family of businesses. Work with one of the nation’s leading health care organizations and build your career at one of our 40+ locations throughout Houston. Be part of a team that is nationally recognized for delivering coordinated and accountable care. As a multi-specialty clinic, we offer care from more than 900 medical providers in 65 medical specialties. Take on a rewarding opportunity to help drive higher quality, higher patient satisfaction and lower total costs. Join us and discover the meaning behind Caring. Connecting. Growing together. Primary Responsibilities: The Director leads the development and execution of the health plan’s Quality and STARs improvement strategy, ensuring solid HEDIS and STARs performance. This role establishes key objectives related to clinical gap closure, disease management, health outcomes, and member experience The Director oversees the full lifecycle of member communications, collaborating with internal stakeholders to implement an effective annual communications plan across all product lines In partnership with other health plan teams, the Director analyzes data and environmental factors to strengthen relationships with members, providers, and community partners, supporting the organization’s overall member experience strategy You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Requirements
- 8+ years of leadership/management experience in the Health Plan Industry and Operations, including experience in HEDIS clinical quality and process improvement
- 8+ years in customer retention or a role requiring relationship management and/or marketing/sales and/or program development and measurement
- Experience with NCQA’s HEDIS data submission process and audits
- Proven knowledge of CMS Quality Ratings, Stars ratings and NCQA accreditation measurements and methodologies
- Experience in provider education programs
- Proven working knowledge of CMS Risk Adjustment requirements
Nice To Haves
- 5+ years of experience in health plan operations
- Ability to be a critical thinker, evaluate merits of new and innovative ideas, and make sound decisions
- Demonstrated solid influence, and the ability to partner with Clinical resources to enable practice transformation
- Ability to create solid relationships and work with Clinical Directors, Medical Directors, Sr. Leadership, as well as business and technology partners to plan, direct and develop clinical programs
- Ability to be a solid communicator and extremely comfortable presenting program objectives, scope, and process across segments
Responsibilities
- The Director leads the development and execution of the health plan’s Quality and STARs improvement strategy, ensuring solid HEDIS and STARs performance.
- This role establishes key objectives related to clinical gap closure, disease management, health outcomes, and member experience
- The Director oversees the full lifecycle of member communications, collaborating with internal stakeholders to implement an effective annual communications plan across all product lines
- In partnership with other health plan teams, the Director analyzes data and environmental factors to strengthen relationships with members, providers, and community partners, supporting the organization’s overall member experience strategy
Benefits
- a comprehensive benefits package
- incentive and recognition programs
- equity stock purchase and 401k contribution
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What This Job Offers
Job Type
Full-time
Career Level
Director
Education Level
No Education Listed
