The Vice President of Quality will Assist the health plan in establishing an in-house Quality Improvement (QI) Department to serve as the accountable department to successfully launch, monitor and maintain a NCQA Accredited health plan. This work will be completed concurrently with the NCQA Health Plan Accreditation Readiness work stream.
- Review, inventory and assess current processes and workflow for health plan and associated Quality Improvement vendors
- Conduct key informant interviews with select vendors and participate in critical vendor transition meetings to inform final output of recommendations
- Prepare an ideal state internal Quality Department organization chart and key roles and sample job descriptions
- Develop a listing of the necessary policies and procedures for the internal Quality Department and other departments along with process and framework to jointly evaluate which services/activities to build within the health plan and those to outsource
- Provide advisory and guidance with the initial hiring process to help build a best-in-class QI department
- Identify other recommended improvements for health plan to implement concurrently to establish a best-in-class health plan (e.g. network development, care models, etc.)
Required Key Deliverables:
- Key informant interviews with up to five (5) vendors to inform recommendations
- Periodic meetings with key health plan leaders to review Quality Department recommendations and progress reports regarding plan implementation
- A 24-month road map that guides the development of a Quality Department including the tasks to be completed by month and accountabilities and the expected cost of implementation
- Recommended organization chart with key competencies and resources for each identified position
- Sample job descriptions for key roles and assistance with hiring
- Charters for Quality Committees within the health plan compliant with NCQA requirements and best-in-class QI divisions
- A listing of the necessary policies and procedures for internal Quality Department beyond those needed for NCQA accreditation (development of P&Ps to be completed in a future work stream if PCHP wishes to proceed)
- A set of high-level recommendations based on a facilitated process for build/buy/lease activities for the Quality Department
- Serve as QI Leadership SME through the development process
- Bachelor’s degree in Business or related field. 10 to 15 years of related experience and 8 to 10 years of increasingly responsible management experience; or an equivalent combination of education, health care, or health insurance management experience with increasing management responsibilities.
- Must be able to travel 75% of time to and from the client site (if not located near client site)
- In addition, at least 5 years’ experience in the oversight of Medicare related programs in a health plan/payer environment, with thorough knowledge of Stars and risk adjustment.
- Management experience in managed care operations.
- Proven ability to lead with an equal balance of strategic agility and execution rigor.
- Demonstrated leadership effectiveness in both formal and influencer roles; dynamic leader that motivates and inspires teams to achieve challenging targets.
- Must possess superior management, negotiation and analytical skills.
- Requires the ability to develop and maintain strong internal and external relationships.
- Must possess excellent verbal and written communications skills.
Job Types: Full-time, Contract
Salary: $180,000.00 to $220,000.00 /year
- Executive Management: 6 years (Required)
- Health Plan: 5 years (Required)
- Quality Assurance: 6 years (Required)
- Health insurance
- Dental insurance
- Vision insurance
- Paid time off
- Retirement plan
This Job Is Ideal for Someone Who Is:
- Dependable -- more reliable than spontaneous
- Adaptable/flexible -- enjoys doing work that requires frequent shifts in direction
- Detail-oriented -- would rather focus on the details of work than the bigger picture
- Autonomous/Independent -- enjoys working with little direction
- High stress tolerance -- thrives in a high-pressure environment