Executive Director of Quality Improvement

Company: Sunshine State Health Plan
Location: West Palm Beach
Posted on: November 4, 2024

Job Description:

At Sunshine State Health Plan, we are transforming the health of our communities, one person at a time.Key Responsibilities

• Quality Improvement Lead - Oversee all activities related to National Committee for Quality Assurance (NCQA) Accreditation and/or Healthcare Effectiveness Data and Information Set (HEDIS) performance, ensuring the highest level of accreditation.
• HEDIS Improvement Management - Manage all aspects of HEDIS improvement activities, including outreach, incentives, data integrity, and chart review.
• Tech Innovations and Process Optimization - Review and implement new technological tools and processes, fostering collaboration with internal and external constituencies.
• Results Presentation and Action Planning - Present results of improvement efforts and ongoing performance measures, recommending action plans to senior management.
• Quality Best Practices Implementation - Research and incorporate quality improvement best practices into operations.
• Operational Efficiency - Organize and control activities, methods, and procedures to achieve business objectives.
• Policy Formulation and Compliance - Formulate and establish policies, operating procedures, and goals in compliance with internal and external guidelines.
• Compliance and Grievance Management - Manage and ensure compliance of EPSDT programs, as well as compliance and turnaround time of grievances and appeals.RequirementsEducation and Experience - Bachelor's degree in Nursing or a related clinical field or equivalent experience; Master's degree preferred. 10+ years of healthcare operations experience, including quality improvement and NCQA accreditation experience. Experience managing acquisition and integration of external data sources. Previous management experience, including responsibilities for hiring, training, assigning work, and managing performance of staff. Familiarity with running Risk Adjustment prospective and retrospective programs preferred.License and Certification - RN license and Certified Professional in Health Care Quality preferred.Compensation - $178,500.00 - $338,800.00 per year. Centene offers a comprehensive benefits package, including competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field, or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. Total compensation may also include additional forms of incentives.Equal Opportunity Employer - Centene is an equal opportunity employer committed to diversity and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.Disability Accommodation - Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act.

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