Sr. Director, Quality Improvement STARS program at Alignment Healthcare USA, LLC in Orange, California

Job Description:

Position Summary:

The Senior Director of Quality Improvement and Stars will lead and drive the strategic development, implementation, and oversight of quality improvement initiatives aimed at optimizing clinical outcomes and achieving 5-star ratings in our Medicare Advantage plans. This role will focus on continuous quality improvement, HEDIS measures, and aligning organizational goals with CMS star ratings requirements. The Senior Director will partner closely with internal and external stakeholders to enhance quality outcomes, ensure regulatory compliance, and drive cross-functional collaboration to improve member care and organizational performance.

Key Responsibilities:

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  Strategic Leadership: Provide strategic direction for the Quality and Stars program, focusing on achieving and maintaining a 5-star rating by implementing robust quality improvement frameworks.
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  Performance Management: Oversee the measurement, tracking, and reporting of key quality performance indicators (HEDIS and Part D) to ensure alignment with CMS regulations and organizational goals.
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  Stakeholder Engagement: Partner with clinical, operational, and network teams to develop action plans for addressing gaps in care, improving patient experience, and ensuring compliance with CMS Star measures.
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  Data-Driven Decision Making: Utilize health care data analytics to assess performance trends, identify opportunities for improvement, and develop targeted interventions that enhance member care and outcomes.
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  Process Improvement: Lead process improvement efforts across multiple departments, ensuring initiatives align with organizational objectives for clinical quality, patient safety, and regulatory compliance.
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  Team Leadership: Manage and mentor a team for Stars performance, ensuring continuous development of skills, knowledge, and leadership abilities within the team.
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  Collaboration and Influence: Cultivate cross-functional relationships with senior leadership, external stakeholders, and regulatory bodies to ensure effective coordination and implementation of quality initiatives.

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  Education: Bachelor's degree in Business Administration, Health Care Administration, Nursing, Public Health, or related field. Master's degree or PhD preferred.
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  Experience:
  
  
  • Minimum of 10 years of experience in healthcare quality assurance/improvement, or a directly related field.
  • At least 7 years of leadership experience in quality improvement, with a focus on Medicare Advantage, including direct oversight of Stars ratings.
  • Proven experience managing large-scale quality improvement projects and operational budgets.
  • Expertise in CMS star rating methodologies, HEDIS, CAHPS, and regulatory compliance.
  • Demonstrated success in driving organizational change and achieving measurable quality improvements.

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  Clinical and Quality Improvement Expertise: In-depth knowledge of clinical quality improvement methodologies, evidence-based practices, and regulatory requirements.
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  Leadership and Collaboration: Proven ability to lead cross-functional teams, influence stakeholders, and drive organizational quality strategies to success.
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  Data Analysis and Decision Making: Strong proficiency in health care data analysis and quality metrics reporting, with the ability to translate data insights into actionable strategies.
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  Project Management: Expertise in project management, including performance measurement, risk management, and process optimization.
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  Communication and Influence: Excellent communication skills, capable of presenting complex information to technical and non-technical audiences, including senior and executive management.
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  Regulatory and Compliance Acumen: Thorough understanding of CMS regulations, quality standards, and audit processes
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  Innovation and Best Practices: Drive the integration of new technologies and innovative methods for process improvement, with a focus on member satisfaction, care access, and clinical outcomes.