Job Location: Orange, CA
Job Description
Why CalOptima?
CalOptima is the single largest health plan in Orange County, serving 880,000 members, or one in four residents. Our motto – Better. Together. – is at the heart of our mission to serve members with excellence, dignity and respect. We are a public agency made up of compassionate leaders and professionals working together to strengthen our community’s health. If you’re looking for an opportunity to work for an organization dedicated to improving local health care and serving the needs of the most vulnerable, we encourage you to join CalOptima.
Job Summary
The Director II (Quality Analytics) is responsible for providing leadership to ensure reporting, tracking and trending of quality performance metrics required by regulators or CalOptima Health leadership. The incumbent oversees the timely delivery of regulatory required Healthcare Effectiveness Data and Information Set (HEDIS) metrics to National Committee for Quality Assurance (NCQA), California Department of Health Care Services (DHCS) and Center for Medicare and Medicaid (CMS) and provides vision to enhance data collection to improve the organization’s quality performance to meet strategic goals. The Director, Quality Analytics is responsible for the strategic vision of the department to meet future expanded requirements of performance measurement evolution from DHCS, Department of Managed Health Care (DMHC) and NCQA. The Director, Quality Analytics is a key thought leader providing frequent feedback to stakeholder organizations including NCQA, DHCS and Association of Community Affiliated Plans (ACAP) regarding proposed, new, or changed quality measurement requirements. Additionally, the incumbent provides leadership for the development, implementation and evolution of provider pay for value programs including alternative payment model programs or incentive programs mandated by DHCS and/or DMHC. The incumbent oversees the development and implementation of all company surveys to measure member and provider satisfaction and, oversees data analytics team that supports population health management, network adequacy reporting and ad hoc quality measurement performance requests. The incumbent coordinates communication keeping senior management and stakeholders informed of health plan and health network quality metrics performance results. The incumbent works collaboratively with management throughout the organization to promote enhancements to organizational performance and supports the Quality Improvement Committee and sub-committees, as well as other key discussions on strategic and policy-related issues.
Position Responsibilities:
- Cultivates and promotes a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.
- Directs and assists the team in carrying out department responsibilities and collaborates with the leadership team and staff to support short- and long-term goals/priorities for the department.
- Oversees the timely delivery of regulatory required HEDIS and Consumer Assessment of Healthcare Providers and Systems (CAPHP) metrics to NCQA, DHCS and CMS and provides vision to enhance data collection to improve the organization’s quality performance to meet strategic goals.
- Participates in strategic planning regarding organizational and quality improvement, including the development of CalOptima Health’s short-term and long-term high level strategic and tactical plans.
- Provides regular and frequent feedback to the Executive Team, Quality Improvement Committee and Board of Directors’ Quality Assurance Committee regarding the status of CalOptima Health’s organizational quality outcomes.
- Oversees the design, implementation, and management of provider incentive programs that are successful and demonstrate positive impact in the health of our members.
- Provides leadership and analytical support resources to NCQA accreditation initiatives including support of the annual Quality Improvement workplan and annual evaluation.
- Participates in workgroups and regulator lead technical calls that address both clinical and non-clinical internal activities for which CalOptima Health must demonstrate improvement to meet its contractual requirements with the CMS, DHCS, DMHC and any other applicable regulatory and/or accrediting entities.
- Oversees the enterprise-wide member experience team and actively participate in helping shape improved member experience for our members.
- Oversees the development and maintenance of those elements of CalOptima Health’s quality improvement plan that support organizational and quality improvement goals and objectives.
- Leads regularly scheduled Quality Forum meetings with Health Network quality champions to communicate health network performance and proposed quality programs or initiatives
- Works with Health Network Management, and other applicable areas to ensure that quality performance is consistently and effectively communicated to health networks, individual providers, CalOptima Health members and other constituents.
- Develops annual staffing and budget plan and monitor resource allocation for the department.
- Works with department directors to ensure sufficient funds are allocated within the medical cost budget for implementing appropriate quality initiatives and incentives and within the administrative budget to ensure cost-effective resources are available to achieve key objectives.
- Manages and grows department staff through selection, orientation, training, performance goal setting, performance review and staff development.
- Ensures department policies and procedures, are annually reviewed and updated.
- Oversees corrective action plan assignments for underperforming entities on quality metrics.
- Supports regulatory audits as requested.
- Completes other projects and duties as assigned.
Possesses the Ability To:
- Analyze and evaluate health data and prepare clear, comprehensive written and verbal reports and materials.
- Communicate clearly and concisely, both orally and in writing.
- Establish and maintain effective working relationships with CalOptima Health’s leadership and staff.
- Educate and motivate others to ensure positive outcomes.
- Handle multiple projects simultaneously and ensure coordination of the various aspects of organizational and quality improvement.
- Manage the performance and encourage the development of subordinate staff.
- Utilize computer and appropriate software (e.g., Microsoft Office: Excel, Outlook, PowerPoint, Word) and job-specific applications/systems (e.g., Tableau) to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.
Experience & Education:
- Master’s degree in Public Health, Healthcare Administration, Healthcare Informatics or related clinical degree required.
- 7 years of quality performance measurement experience (HEDIS, STARS, MCAS, etc.), including quality improvement activities related to data required.
- 5 years of progressive leadership experience, including direct supervision of staff required.
Preferred Qualifications:
- Previous experience making presentations to senior level management, stakeholders and Board members preferred.
- Previous experience utilizing a NCQA certified HEDIS reporting tool to generate HEDIS results end-to-end preferred.
- HMO, Medi-Cal/Medicaid, Medicare and managed care quality measurement experience preferred. Managed care experience in a highly delegated model preferred.
Knowledge of:
- NCQA, CMS, DHCS and other quality metrics, standards and regulatory requirements.
- CAHPS and HEDIS requirements.
- Pay for Value Programs and Implementation.
- Legislative, regulatory, financial, data and program requirements for health care service delivery to beneficiaries of Medi-Cal and Medicare.
- Principles and practices of managed health care, health care systems, and medical management administration.
Department(s): Quality Analytics
Reports to: Executive Director, Quality and Population Health
FLSA status: Exempt
Salary Grade: R – $69.23 – $107.88 ($144,000 – $224,400)
CalOptima is an equal employment opportunity employer and makes all employment decisions on the basis of merit. CalOptima wants to have qualified employees in every job position. CalOptima prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics.
If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability. You can request reasonable accommodations by contacting Human Resources Disability Management at 657-900-1134
Job Location: Orange, California
Position Type:
To apply, visit https://jobs.silkroad.com/CalOptima/Careers/jobs/3998
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