Vice President, Quality (RN, CPHQ - Health Plan)

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Maryland Heights, MO
$150,000 - $220,000
Job Type
Direct Hire
Bachelor, Master
Dec 11, 2018
Job ID

Nationwide Search for Vice President, Quality & Process Improvement (Health Plan) (RN, CPHQ)

Position Purpose:
As the senior leader, reporting to the Chief Medical Director, you will be responsible for developing and overseeing the quality improvement functions..
To be part of the leadership team to lead and direct process improvement activities, streamline the workflow for a more efficient process.
To oversee business processes related to risk adjustment and quality improvement activities across the organization of this Fortune 100 company.

Driving performance improvement for HEDIS, Stars, State Contract Quality & Pay for Performance/Withhold, and Marketplace QRS
Medicare Quality metrics and processes
Other quality improvement opportunities

  • Develop infrastructure and processes for management of activities related to National Committee for Quality Assurance (NCQA) Accreditation and Healthcare Effectiveness Data and Information
  • Set (HEDIS) performance ensuring the highest level of accreditation
  • Manage all aspects of HEDIS improvement activities, including outreach, incentives, data integrity and chart review
  • Oversee the development and implementation of enterprise-wide and market-specific process improvement programs
  • Review and present results of quality interventions for clinical and operational performance improvements and identify organizational risks to executive management
  • Develop and ensure consistent, reliable and valid application of data collection and analysis for priority performance measures, including HEDIS, pay for performance and contractual performance measures
  • Review and analyze cost-benefit and return on investment analyses for organizational resource allocation and recommend action plans
  • Formulate and establish policies, operating procedures, and goals in compliance with internal and external guidelines
  • Manage and ensure compliance of EPSDT (Early and Periodic Screening, Diagnostic and Treatment) child health component program of Medicaid as well as compliance and turnaround time of grievances and appeals
Bachelor's degree in Nursing or related clinical field or equivalent experience
Master's in Nursing or Business Administration preferred
10+ years of healthcare operations experience including, quality improvement and NCQA accreditation experience.
Experience managing acquisition and integration of external data sources
Previous management experience including responsibilities of hiring, training, assigning work and managing performance of staff
Familiarity with running Risk Adjustment prospective and retrospective programs preferred 

Certified Professional in Health Care Quality (CPHQ).
RN License preferred.

Compensation: Substantial base salary with 20% or higher Bonus and Generous Relocation package will be offered to the right candidate.