Senior Director, Improvement

Responsibilities

Prominence Health is a value-based care organization bridging the gap between affiliated health systems and independent providers, building trust and collaboration between the two. Prominence Health creates value for populations and providers to strengthen integrated partnership, advance market opportunities, and improve outcomes for our patients and members. Founded in 1993, Prominence Health started as a health maintenance organization (HMO) and was acquired by a subsidiary of Universal Health Services, Inc.

(UHS) in 2014. Prominence Health serves members, physicians, and health systems across Medicare, Medicare Advantage, Accountable Care Organizations, and commercial payer partnerships. Prominence Health is committed to transforming healthcare delivery by improving health outcomes while controlling costs and enhancing the patient experience.

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The Senior Director, Performance Improvement provides strategic leadership in the planning, development, implementation and execution of all aspects of a robust Risk Adjustment and STARS/HEDIS Program across Prominence Health Plan’s (PHP) Medicare Advantage and Commercial lines of products. The objective of this position is to ensure compliance with CMS coding and documentation requirements in order to optimize clinical quality and revenue opportunities for Prominence Health Plan as well as to oversee the comprehensive quality measurement initiatives such as HEDIS and STARS, including reporting and compliance maintenance.

Key responsibilities include optimizing PHP revenue opportunities by ensuring members receive appropriate medical care that is accurately coded so that the members’ risk scores are optimized and compliant with regulatory reporting standards. The Senior Director oversees all aspects of the plan’s HEDIS operations including measure improvement programs, data integrity, chart retrieval and abstraction efforts, audit compliance, and annual submission or rates as well as identifies strategies to improve performance across all STARS/HEDIS measures.

The Senior Director has programmatic oversight and responsibility for achieving all risk adjustment, quality, and member satisfaction performance goals of the Prominence Care Centers. The Senior Director works closely with clinical and business leaders and oversees the development and implementation of population health and quality improvement initiatives aligned with PHP’s clinical, business, quality measurement, and improvement strategies.

Must work collaboratively with other PHP departments, including Actuarial, IT, Legal, Health Services, Network Management, Quality Improvement and others to manage the risk adjustment and STARS process. Must develop or purchase tools that will result in leveraging information to manage member analytics in order to more effectively direct resources and activities to meet risk adjustment and STARS objectives. In carrying out these responsibilities, The Senior Director works closely with external vendors and consultants, runs outsourced health risk assessment programs, develops training programs & tools to address the educational needs of providers and non-clinical staff, assists in the development of analytic and reporting tools, and assists in the development of data collection systems and workflows to fulfill CMS and quality measurement requirements.

• Loan Forgiveness Program
• Challenging and rewarding work environment
• Competitive Compensation & Generous Paid Time Off
• Excellent Medical, Dental, Vision and Prescription Drug Plans
• 401(k) with company match and discounted stock plan
• SoFi Student Loan Refinancing Program
• Career development opportunities within UHS and its 300+ Subsidiaries!
• More information is available on our Benefits Guest Website:

One of the nation’s largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (UHS) has built an impressive record of achievement and performance. During the year, UHS was again recognized as one of the World’s Most Admired Companies by Fortune; and listed in Forbes ranking of America’s…