The Director of Quality Services is responsible for operationalizing a strategy that will promote success in achieving the organization’s goals for quality improvement. This position provides oversight, project management of complex improvement activities as well as direction to assure the organization’s quality improvement program and work plan are implemented and meet CMS, state and NCQA requirements. Development and maintenance of effective working relationships with CMS, state and accreditation organizations is essential. Major responsibilities include development and completion of quality improvement projects and interventions, direction of the quality improvement committee and sub-committees and quality of care investigations.

 

ESSENTIAL DUTIES AND RESPONSIBILITIES:

 

·        Educates staff on the principles of quality improvement and acts as a staff resource for quality improvement questions

·        Coordinates the development of the annual Quality Improvement Work Plan and refines the Work Plan on a go forward basis

·        Coordinates the Annual Quality Improvement Program Evaluation

·        Ensure that all quality improvement activities are reviewed on a regular basis according to applicable NCQA, CMS and state standards and plans of correction are tracked and outstanding issues addressed in a timely manner

·        Develop policies and procedures and standard operating procedures as needed

·        Collaborate with departments to address gaps and open tasks

·        Oversees risk management/quality of care issues investigation, tracking and analysis

·        Project leader for Quality Improvement and Performance Improvement Projects including HEDIS initiatives

·        Liaison with Marketing and Provider Network on development of member and provider health education materials

·        Identify training needs of staff and resources related to CMS, State, NCQA and other quality standards. Facilitate training in these areas

·        Coach staff on standards and documentation to demonstrate compliance

·        Works with other departments to develop quality benchmarks, indicators and reports

·        Develops the Quality Improvement Committee agenda and coordinates committee activities, meetings and follow-up

·        Create reports for state Medicaid programs, CMS, EQRO and NCQA organizations

·        Assist and support VP, Quality as required

·        Other duties as requested

 

·        Knowledge of NCQA and government standards and participation in a CMS or NCQA review is required

·        Experience in quality improvement in a managed care setting required

·        Experience as a leader in complex or system-wide project management required

·        Professional attitude and team player, with ability to work independently

·        Experience coaching and mentoring staff

·        Excellent phone/communication skills

·        Ability to comprehend technical documents

·        Multiple task oriented

·        Flexible with the ability to shift priorities on short notice

 

·        Master’s Degree required, Health Care or Business preferred

·        Health care professional currently licensed in Maryland strongly preferred

·        Two years experience with HEDIS and other data driven quality improvement reports

·        Familiarity with project management process and tools

·        Advanced skills with ACCESS and EXCEL

·        Minimum of one year experience in clinical or service improvement study design and research required