Associate Director, Quality Improvement

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The Associate Director, Quality Improvement is responsible for working with appropriate departments in the areas of clinical, health services, compliance, process improvement, and member/provider satisfaction for Ohio Medicaid. The Associate Director, Quality Improvement requires a solid understanding of how cross collaboration and organizational capabilities interrelate across department(s). The Associate Director, Quality Improvement requires a high-level knowledge of HEDIS®, CAHPS®, Performance Improvement, and managing a team of associates.

The Associate Director, Quality Improvement implements quality improvement programs and is responsible for enterprise-wide strategy in clinical quality areas in order to maintain a consistent approach across business lines. Decisions are typically related to identifying and resolving complex technical and operational problems within department(s) and leads multiple associates and highly specialized professional associates.

• Will lead the alignment of Quality Associates and Population Health Stream strategies.
• Lead the focus on MPS measures by population stream and strategy to mitigate penalties.
• Lead the focus on QBA measures and strategy to maintain performance related to membership assignment.
• Focus on HEDIS® project deliverables, driving results and improvement by population stream.
• Focus on CAHPS® project deliverables and impact to population streams (Children, Adults, Behavioral Health, Maternal Health, and Chronic Conditions).
• Provide oversight of Cross-stream Quality Withhold collaborative efforts.
• Lead efforts and focus on vendor and provider engagement from a Quality perspective with dedicated resources and cross collaborative efforts.
• Lead efforts on maintaining quality documentation including policies/procedures, committee minutes/materials, and program documents.
• Lead efforts on maintaining NCQA and EQRO compliance.
• Responsible for maintaining confidential information in accordance with policies, and state and federal laws, rules, and regulations regarding confidentiality.
• Use your skills to make an impact.

• 4 or more years of experience working within Medicaid.
• 2 or more years of current or previous leadership experience (Ideally any experience in leading quality improvement and/or compliance professionals).
• Experience in Quality Improvement/Process Improvement in the healthcare field.
• Understanding of cultural factors that influence health outcomes and implementing culturally competent improvement interventions.
• Demonstrated skills in quality improvement concepts, health care data analysis, data mining methods and the identification of population health issues, trends, and health disparities using health care data sources.
• Understanding of value-based payment models that reward quality improvement.
• Excellent communication and presentation skills to include the ability to communicate and present technical/financial details to Senior VP level leadership and/or Senior Government officials.
• Critical thinker who can anticipate team needs and take initiative to present ideas, ask the right questions and deliver the highest quality work.

• Ohio residency is strongly preferred but consideration will be given to non-Ohio based candidates that reside within a driving commute to Columbus, Ohio.
• Associate's Degree in practical nursing, health administration, health policy or business or equivalent work experience.
• CPHQ (Certified Professional in Healthcare Quality) Certification.
• Knowledge of QI methodologies (i.e. IHI model of improvement and familiarity with QI Tools (i.e. FMEA, KDD, workflows/diagrams, root cause analysis etc..)).
• Knowledge of Humana's…