Director Health Plan Quality

Job Summary: Director, Health Plan Quality is accountable for defining strategic direction of the Health Plan Quality programs and has responsibilities for the development, implementation, monitoring and evaluation of HEDIS, NCQA, PCMH and Medicare Stars programs.
The Director will serve as an internal expert, consultant and resource to support plan goals around improved quality of care, reduced medical and administrative costs, and improved efficiencies across the care continuum for the Hawaii Market.
Anticipates problems and seeks solutions to ensure on-going operations in Quality Health Plan and drives quantitative and qualitative analysis to support the regional quality strategy.
Ensures continue high levels of performance with regulatory, accreditation and internal requirements including but not limited to NCQA, Medicaid, CMS, and PCMH.
Has oversight/planning of the Market Quality oversight committee, facilitates development of the Market Quality Program Description, workplans and evaluations.
Identifies strategies and solutions to business and operational challenges.
Ensures effective management analyses is performed as requested for medical outcome studies/projects.
Follows through with quality interventions in partnership with physicians, managers, supervisors and frontline staff.
Supervises assigned staff.
Essential Responsibilities: · Provides leadership and strategic direction for regulatory, accreditation, and internal program performance oversight for the Quality Health Plan in the Hawaii Market · Form relationships and work collaboratively with a diverse group of stakeholders.
· Champions new ways of meeting targets and/or goals.
· Continuous knowledge of new government standards, requirements and regulatory environment to enable region to prepare strategies for future implementation.
· Provides consultation and analysis regrading performance and strategic opportunities as defined.
· Assesses and articulates issues and problems from a broader organization/mission perspective.
· Identifies the most effective means of problem solving.
· Facilitates committee and task forces.
· Oversees effective clinical quality programs, policies, standards, practices and procedures consistent with organizational objectives as related to the integrated and network models of care.
· Works in collaboration with the Medical Group, operational departments and National office to ensure high level of performance with regulatory, accreditation and internal requirements and surveys (e.
g.
NCQA, CMS, Medicaid, etc.
) · Assess and articulates issues or problems and identifies the most effective means to solve them.
· Report and presentation development to support regulatory/compliance submissions.
· Expert resource with business leadership, IT, employees and outside consultants, vendors, agencies, and network on behalf of Kaiser Permanente Hawaii.
· Maintains procedures and instructions for self-assessment, performance monitoring and improvement programs as needed.
· Hires, trains, supervises, counsels, disciplines, and terminates assigned staff as appropriate.
· Communicates goals, objectives, accountabilities, priorities, and authority parameters to assigned staff.
Basic Qualifications: Experience Minimum seven (7) years of managed health care organization experience with a minimum three (3) years in supervisory/management role.
Education Bachelors degree in business administration, health care or related field OR four (4) years of experience in a directly related field License, Certification, Registration N/A Additional Requirements: Thorough knowledge of federal and state laws and regulations.
Preferred Qualifications: Master degree in business administration, health care or related field OR six (6) years of experience in a directly related field.
PrimaryLocation : Hawaii,Honolulu,Moanalua Medical Offices HoursPerWeek : 40 Shift : Day Workdays : Mon, Tue, Wed, Thu, Fri WorkingHoursStart : 08:00 AM WorkingHoursEnd : 05:00 PM Job Schedule : Full-time Job Type : Standard Employee Status : Regular Employee Group/Union Affiliation : NUE-HI-01|NUE|Non Union Employee Job Level : Director/Senior Director Job Category : QA, UR & Case Management Department : Mapunapuna Medical Offices - Rgnl Quality Resource Mgmt - 1208 Travel : No Kaiser Permanente is an equal opportunity employer committed to a diverse and inclusive workforce.
Applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), age, sexual orientation, national origin, marital status, parental status, ancestry, disability, gender identity, veteran status, genetic information, other distinguishing characteristics of diversity and inclusion, or any other protected status.