Director of Quality Services
Rapidly growing Medicaid-Medicare Health Insurance Plan
Location: Baltimore MD: Local Candidates Preferred

About the opportunity: We are a rapidly growing health plan currently serving over 350,000 members in over 40 states, in partnership with over 30,000 physicians. Uniquely focused on providing a variety of Medicare Advantage and Part D Prescription Drug plans, each of our members is empowered with the information that they need to tailor the right coverage to fit their specific healthcare needs, budget and lifestyle. Our Baltimore headquarters capitalizes on the proximity of the Centers for Medicaid and Medicare Services (CMS), offering local candidates significant long term career potential. Our uniquely consumer-driven health plan provides our valued members both rich choice and exceptional value – which has driven great demand for our health plan offerings.

About the Position: To ensure we continue to provide the highest quality healthcare, we need a Director of Quality Services to join our leadership team. The successful candidate must be a licensed nurse, and will be responsible for translating our organization’s strategic quality improvement goals into an implementable operating plan. The successful candidate will oversee and manage complex performance improvement initiatives and projects, including working to ensure that our quality improvement programs we implement meet corporate goals as well as the regulatory requirements of CMS and NCQA. The successful candidate will be our point person for fostering. effective working relationships with CMS, and accreditation organizations on the national level, as well as with appropriate insurance and regulatory bodies at the state level. In addition to developing and implementing quality improvement projects and appropriate interventions, the successful candidate will chair our quality improvement committee, and oversee quality-related investigations.

Responsibilities: The successful candidate will have a proven track record of success:

• Educating and training staff on key principles of quality improvement, (including CMS, State, NCQA etc) while serving as a resource to staff for quality improvement questions
• Coordinating the development of the annual Quality Improvement Program, refining the Work Plan on an on-going basis, and conducting an annual evaluation.
• Ensuring that 1) all quality improvement activities are reviewed regularly, 2) for compliance with the appropriate NCQA, CMS and state standards, and 3) that correction plans are developed, monitored and outstanding issues are addressed in a timely manner
• Acting as Project Manager and Thought Leader for Quality Improvement and Performance Improvement Projects (including HEDIS initiatives)
• Collaborating with Marketing and Provider Network in developing member/provider materials
• Working with other departments to develop quality benchmarks, indicators and reports
• Creating reports for state Medicaid programs, CMS, EQRO and NCQA organizations

Requirements: The successful candidate will meet the following minimum qualifications:

• a Registered Nurse currently licensed in the state of Maryland strongly preferred
• Proven successful quality improvement leadership experience in managed care setting
• strong project management skills –honed in a large, complex or system-wide initiative, as well as productivity tools, and advanced skills with Microsoft Access and Excel.
• at least one year experience in a clinical or service improvement study design and research project.
• at least two years experience with HEDIS (and similar information-intensive, data-driven quality improvement reports)
• Hands on knowledge of NCQA and government standards, including past successful participation in a CMS or NCQA review

To Apply / Learn more: Please specify “Director, Quality Services” when forwarding your resume, target salary range (in strictest confidence) to Ann@BolandGroup.com. 

 

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