SSM Health Regional Director of Continuous Improvement in Saint Louis, Missouri
Establishes strategic direction and manages staff (direct/indirect reports) working on quality analytics, reporting, and improvement initiatives. Ensures clinical intervention staff (indirect resources) activities are aligned to overall quality goals/plans and activities are effectively implemented.
Develops strategy of provider incentives, pharmacy programs, internal quality campaigns, and vendors related to, or impacting, quality metrics including STARS. Develops and implements quality improvement plans for HEDIS/STARS with related initiatives/interventions required from continual monitoring of relevant quality measures. Ensures quality reporting is performed routinely with gap identification and reporting to physicians and clinical outreach teams. Provides management reporting/analytics of STARS and HEDIS results to senior leadership.
Ensures periodic review of approaches to optimize quality results including analytic toolsets, data management, provider contract incentives, product design, and intervention approaches.
Develops provider and member outreach models to close quality gaps. Ensures distinct owner/non-owner approaches are developed for providers, utilizing provider quality benchmarking and incentives.
Participating and influential member of product to operations team and product planning team; teams are responsible for product design, service models, implementation and go-to-market strategies. Participates and chairs various committees focused on clinical activities.
Manages risk team coordinator staff and related interventions to optimize clinical coding and member risk scores for commercial and government segments.
Partners with provider contracts in development/revisions of pay for performance programs to support quality management; SME for provider contracts related to quality as needed during negotiations.
MAPD Product Line (standing) member of appeals & grievances committee. Provides peer review of audit processes, appeals and grievances reporting, documentation and remedies to ensure that organization meets regulatory requirements. Adapts product and service attributes as needed to alleviate stakeholder pain points.
Ensures adequate policy and procedure documentation are maintained for Medicare Advantage and quality management activities.
Business unit lead for MAPD CMS and regulatory; ensures direct and indirect resources are aligned to support regulatory audits.
Performs other duties as assigned.
- Bachelor’s degree in relevant field
- Ten years’ healthcare experience, with five years’ in leadership
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