Vice President and Chief Quality Officer (CQO)

Trusted Health Plan
Washington, DC
Jun 14, 2017
Jun 21, 2017
Full Time
Trusted Health Plan provides high-quality, cost-effective managed health care services for underserved populations. We have an established footprint and high-touch approach to managing care throughout the area's we serve. If you are committed to raising the bar in public health care and making Trusted Health Plan the health care plan of choice for the most vulnerable residents, we want to talk with you.We are looking for the best and the brightest problem-solvers who are dedicated to changing the way health care is delivered and are passionate about creating a better model for our national health care system. We offer a professional working environment, competitive salaries and excellent benefits. As we continue to grow, we are seeking an experienced:Vice President and Quality OfficerWashington DC The VP & Chief Quality Officer (CQO) role is a newly created position within the health plan and will focus on leading system-wide quality for our District of Columbia Medicaid Managed Care program. The CQO is the senior executive responsible and accountable for the administrative success of the Quality Assessment and Performance Improvement (QAPI) Program and the Continuous Quality Improvement (CQI) plan for our District of Columbia Medicaid Managed Care Program. This is a highly collaborative and strategic role requiring substantial experience as a clinical leader in the QI space. The CQO will provide the strategic vision and leadership to drive innovative quality and performance improvement initiatives across the enterprise and system-wide. The CQO will engage and lead our internal team and network, non-network, subcontracted and delegated Providers in CQI activities for services rendered to Enrollees. The CQO will oversee the development of clinical strategies including the development clinical programs and population health initiatives. The Chief Quality Officer shall work in collaboration with the Chief Medical Officer and the Quality Improvement Manager. In concert with other members of the clinical leadership team, the CQO will be responsible for systems and process redesign and the implementation of evidenced-based best practices. Additionally, the CQO is responsible for oversight of accreditation, HEDIS, performance-based incentive program and ensuring compliance with the District, CMS and other applicable regulatory agencies. The CQO will also be involved in the development of quality measures for value-based payment models. The CQO will oversee a team of QI Clinical Quality team members. The CQO reports to the CEO, an energetic leader with significant expertise in Medicaid Managed Care.POSITION DUTIES AND RESPONSIBILITIES Direct development, implementation and evaluation of the QAPI program and the CQI plan. Coordinate Trusted's QAPI program and CQI plan with the activities of the District's External Quality Review Organization (EQRO) and any performance measurement and quality improvement activities or initiatives mandated by the District. Collaborate with the CMO on health care performance measurement and quality improvement activities. Provide oversight of the quality of clinical care provided by network, non-network, subcontracted and delegated Providers for services rendered to Enrollees. Lead multi-disciplinary resources to review Adverse Events and take appropriate action based on the review. Provide clinical expertise towards the development of strategic, operational and tactical clinical programs designed to improve the overall health of the population Provide leadership, clinical oversight and guidance to maintain the highest levels of service quality. Provide direction for risk adjustment activities and revenue maximization. Recruit, develop, motivate and manage high caliber QI Clinical Quality and management staff Maintain a positive work environment that supports self-directed initiatives; provide a structure to optimize the skill, knowledge and capability of clinicians and the management team. Develop and maintain collaborative relationships with regulatory agencies such as DHCF, DOH, DBH, NCQA, CMS, etc. to ensure that all protocols and procedures are consistent with regulatory requirements and aligned with other programs in the District. Participate in monthly CQI meetings with DHCF and the EQRO. Build consensus and maintain collaborative alliances with internal and external customers. Manage budget and control expenses while meeting goals and objectives. Participate in the development of appropriate benchmarks for quality key indicators Provide Clinical input to the development of profiling and monitoring programs related to the quality of medical services provided by participating providers Provide advice and counsel on medical and clinical matters related to the Plan. Participate in the strategic planning and operational decision making of the Company. Provide Clinical staffing support and input to the QEC of the Board of Directors. Participate in collaborative efforts to partner with risk owner hospital medical, care management, administrative, and financial staff to establish and enhance clinical programs and maximize revenue. QUALIFICATIONS RN or MD with active, unrestricted District of Columbia medical license plus MBA/MPH desirable 3+ years of successful leadership experience of a health plan Quality Improvement department and performance excellence in a managed care environment Demonstrated leadership in HEDIS and NCQA with demonstrated success in taking an MCO through CMS, State, and NCQA audits/site visits. 3 - 5+ years Managed Care clinical leadership experience, preferably in Medicare/Medicaid plans 3 - 5+ years successful experience in developing and managing a Clinical Quality team and associated operating budget is highly preferred. 3 - 5+ years' experience working as a part of cross-functional, self-directed teams is preferred. Strong working knowledge of national trends and involvement with national QI organizations Exceptional communication and presentation skills Ability to balance service provision with cost containment. Knowledge of health care finance and economics. Broad clinical leadership expertise encompassing quality, utilization management, care coordination and case management, disease management, wellness, prevention, early intervention including Special Needs. Experience in developing and analyzing care management programs that have demonstrated both clinical and financial improvements in a managed care setting. Strategic mind with strong independent decision making ability. Inspirational leadership style with exceptional staff development, team-building and mentoring skills.In exchange for your prior experience and talents, you will enjoy our generous compensation and benefits package. If you feel like you would be a great fit for this opportunity, and would like to join a dynamic, growing organization, we encourage you to apply today.Equal Opportunity Employer