Sr. Director, Clinical Quality
About The Position
Your Role Reporting to the VP, Quality, the role of the Sr Director, Clinical Quality is critical to the success of Blue Shield of California and the Clinical Quality department in realizing its goals and objectives. This individual will play a key role as part of the Quality team in delivering and collaborating on all aspects of quality outcomes. Responsible for the performance of all quality rating systems and for the development of strategic plans and programs to support continuous quality improvement. Developing, assessing, and delivering on interventions, policies, and procedures at all levels and with critical operational departments to ensure quality programs will meet or exceed guidelines or requirements. Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow – personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.
Requirements
- Bachelor’s degree required in Nursing, Public Health, or other related field.
- Minimum of 10 years of relevant experience required including 8 years of management experience.
- Expertise in HEDIS specifications and outcomes.
- Minimum of 5-10 years’ experience leading Quality Improvement efforts to improve HEDIS outcomes through provider and member engagement activities.
- Industry leading expertise and connections across the Quality Improvement community industry-wide.
- Deep knowledge of data and analysis relevant to improving Quality performance.
Nice To Haves
- Master's degree in relevant field preferred.
Responsibilities
- Working with the VP, Quality, to build out a detailed strategy to execute on multi-year quality plans which may include unique strategies for ACO, HMO, PPO and Medi-Cal delivery models. The quality plans will include staffing needs, infrastructure development, and partnering with other parts of the organization.
- Manage a team of direct reports including several critical leaders and teams which deliver critical quality programs, models and operations.
- Act as thought leader within BSC on methods to change member health behaviors and physician practice style that impact and improve quality outcomes.
- Represent BSC on Quality at conferences and in statewide and national initiatives, and with state and federal regulators as necessary.
- Evaluate and evolve current quality improvement and pay for performance programs using technology, member engagement strategies, partnerships with providers, incentives and other methods."
- Partner with other BSC teams to enhance and customize programs to populations of members and providers.
- Implement quality programs regional network specific strategy by working with internal and external organizations to disseminate and improve quality initiative uptake.
- Develop and oversee provider incentive programs. Evaluate success of the programs and adjusting annually to drive outcomes.
- Oversee Medical Record Review and abstraction strategy and process.
- Evaluate and Report Performance on Quality and Member Experience.
- Conduct program evaluations to inform revisions and refinements to interventions.
- Ensure regulatory compliance and oversee audits.
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
What This Job Offers
Job Type
Full-time
Career Level
Director
