Director, Quality

Location
Virginia Beach, VA
Salary
Competitive
Posted
Nov 26, 2018
Closes
Dec 26, 2018
Ref
118178BR
Function
Nurse
Industry
Healthcare
Hours
Full Time
Overview:

Optima Health is hiring a Registered Nurse (RN) to serve in the role as Director of Health Plan- QI and lead our Quality Assurance teams in Virginia Beach and Norfolk, VA.


Department/Position Overview:

As the Director of Quality Improvement- Health Plans, this Registered Nurse (RN) will lead all of the Quality Improvement Program for the health plan. This includes 2 direct report (managers) and multiple indirect reports (RNs, admin, support). Both a Master's Level Degree (any major) and a Bachelor's of Nursing (BSN) degree are required as well as 5 years of Healthcare Quality with 3 years of Health Plan Quality Improvement Experience ; 3 years of NCQA Health Plan Accreditation; and 5 years of supervisory all required. Additionally 3 years of Project Management and/or Population Health is strongly preferred.


Division Highlights:

Optima Health offers a full suite of commercial health insurance products including employee-owned and employer-sponsored plans, as well as Individual and Family health plans, employee assistance plans and plans serving Medicare and Medicaid enrollees. We offer programs to support members with chronic illnesses, customized wellness programs, and integrated clinical and behavioral health services.

As a nationally recognized provider of health plan coverage and innovative wellness programs, we live our mission "to improve health everyday." This same commitment and dedication directs our philosophy as an employer. When you join Optima Health, you will experience our deep passion for heal and service excellence while benefiting from a culture of opportunity, learning, career growth, and support --every day. Optima Health is a service of Sentara Healthcare, so joining Optima is joining the Sentara Healthcare family.


Sentara Benefits:

Sentara employees strive to make our communities healthier places to live. We’re setting the standard for medical excellence within a vibrant, creative, and highly productive workplace. For more information about our employee benefits, CLICK HERE!

Join our team, where we are committed to quality healthcare, improving health every day, and provide the opportunity for training, development, growth!


Other
Both Master's Level Degree and RN Bachelor's Level Degree are required

3 years Health Plan Quality Improvement experience required

3 years NCQA Health Plan Accreditation required

3 years Population Health experience preferred

Keyword: Registered Nurse, RN, Quality Improvement, QI, QA, Quality Assurance, health plan, NCQA, population health, project management, manage care

Equal Opportunity Employer

Responsibilities:

The Director, Health Plan Quality Improvement reports to and works closely with the Senior Medical Director to achieve the strategic objectives of the QI Department. Effectively engages all departments around quality activities and performance improvement. Directs the health plan efforts pertaining to NCQA, HEDIS, CAHPS, CMS STAR ratings and other quality measurement and accreditation. Ensures compliance with contractual quality requirements and reporting for government, commercial and other lines of business. Analyses plan quality data to identify areas for improvement. Designs, implements and manages policies, procedures, and improvement projects to achieve quality performance goals. Builds strategic relationships with internal and external stakeholders including providers to promote and achieve the quality performance goals. Identify business needs, evaluate external vendors, selects best vendor, negotiates business agreement, manages vendor relationship, evaluates vendor performance, implements corrective plans for under-performance, terminates vendor relationships if corrective action is unsuccessful.

Qualifications:

Education Level
Master's Level Degree OR
RN-Bachelor's Level Degree

Experience
Required: Healthcare Quality - 5 years, Supervisory - 5 years

Preferred: Project Management - 3 years

License
Required: Registered Nurse

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