The position is a crucial role in overseeing and directing quality improvement initiatives within MedStar Family Choice.
Responsible for developing and implementing strategies to enhance the quality of care, improve health outcomes, and ensure compliance with regulatory standards.
The Director collaborates with cross-functional teams, healthcare providers, and external stakeholders to drive continuous quality improvement and promote a culture of excellence in healthcare delivery.
This is a pivotal role in developing and implementing a comprehensive quality improvement strategy that aligns with MedStar Family Choice's mission, vision, and strategic objectives.
Leads cross-functional teams, collaborates with healthcare providers and network partners, and engages with regulatory agencies to drive continuous improvement in healthcare quality and performance.
Identifies quality improvement priorities, sets measurable objectives, and implements evidence-based interventions to address identified quality gaps in care.
Leverages advanced analytics and data-driven insights to monitor performance, identify trends, and drive actionable recommendations for improvement.
Fosters a culture of quality and accountability by communicating, collaborating, and working closely with internal departments, healthcare providers, and external stakeholders.
Provides training, education, and support to internal staff and network partners on quality improvement methodologies, performance measurement, and regulatory requirements.
EducationBachelor's degree in healthcare field (BSN preferred) requiredMaster's degree in healthcare field preferredExperience5-7 years Quality improvement experience within a health plan, preferably a managed Care Organization (MCO)3 years supervisory experience5-7 years Diverse clinical experience requiredLicenses and CertificationsRN - Registered Nurse - State Licensure and/or Compact State Licensure Valid RN license in the local area serving (State of Maryland or District of Columbia); Upon Hire preferredCertification in healthcare related field Upon Hire preferredCPHQ - Certified Professional in Healthcare Quality CPHQ certification Upon Hire preferredKnowledge, Skills, and AbilitiesKnowledge of current trends in health care delivery and population managementKnowledge of NCQA, HEDIS, EQRO audits and local regulatory guidelines preferredStrong analytical skills, technical writing skills, excellent problem-solving skills and ability to exercise independent judgmentBusiness acumen and leadership skillsStrong verbal and written communication skills with ability to effectively interact with all levels of management, internal departments and external agenciesProficient with Microsoft Office applications especially Word, Excel and PowerPointAbility to enter and retrieve information using a PCWorking knowledge of various computer software applicationsResponsibilitiesLeads the development and implementation of a comprehensive quality improvement strategy aligned with MedStar Family Choice goals and objectivesIdentifies key areas for improvement, sets measurable objectives, and establishes performance metrics to monitor progress and outcomesDirects and oversees quality improvement initiatives across the health plan, including but not limited to HEDIS measures, EPSDT measures, NCQA, and EQRO accreditationCollaborates with cross-functional teams to develop action plans, implement interventions, and monitor performance against quality targetsUtilizes advanced data analytics and healthcare informatics to analyze healthcare data, identify trends, and drive performance initiativesDevelops and maintains comprehensive reports, dashboards, and scorecards to track quality metrics, performance trends, and improvement opportunitiesPrepares, analyzes, and oversees special reports such as CAHPS, EPSDT, Provider Satisfaction, Annual Technical Report, SPR, Performance Improvement Projects (PIPS), Value Based Purchasing (VBP), and Encounter Data ValidationOversees and supervises annual quality audits performed by the external quality review organization (EQRO) and NCQA, HEDIS, EPSDT, Encounter Validation Data, Network Adequacy Validation, and System Performance ReviewLeads efforts to continuously evaluate and improve quality improvement processes, tools, and methodologies based on industry best practices and organizational needsFosters a culture of continuous improvement by encouraging innovations, soliciting feedback, and empowering staff to take ownership of quality improvement initiativesCoordinates and conducts studies for the various quality measures required by State regulatory guidelines and NCQA.
Evaluates member satisfaction and provider satisfaction and makes modifications as necessary to improve satisfactionProvides training, education, and support to internal staff, healthcare providers, and network partners on quality improvement methodologies, performance measurement, and regulatory requirementsFacilitates learning opportunities and knowledge-sharing sessions to promote awareness, understanding, and adoption of quality improvement best practicesAssists with organizing the agenda and actively participates in Quality Improvement Committee meetings, other departmental meetings, and State meetings as directed.
Oversees the preparation and distribution of agendas and minutes for committee meetingsDevelops department goals, objectives, policies, and procedures.
Ensures compliance with business unit policies and procedures and governmental and accreditation regulationsSupervises and monitors the effectiveness of contracted vendors who assist with outreach, wellness, member/enrollee service, and quality efforts.
Oversees the development of a Corrective Action Plan when goals are not metOversees the development, preparation, and delivery of meaningful real-time Provider Scorecards to MFC's participating providers to educate, inform, and assist them in obtaining MFC's goals and objectivesWorks collaboratively with the Information Systems Team and Senior Data Analyst to develop reports to meet the department's annual objectives.
Uses technology to enhance decision-making and effectivenessOversees the development, implementation, and revision of wellness and preventative care programs, goals, and interventions.
Ensures that each area meets targeted goals as determined by the regulatory jurisdiction such as Value Based Purchasing (VPB), EPSDT, and HEDIS.
The goal is at minimum neutral to incentive targets and/or NCQA 75th to 90th percentileIdentifies target populations, geographic areas, and key stakeholders to prioritize outreach efforts and maximize impact
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