Medicaid Quality Management Health Plan Director
Core
Direct clinical quality initiatives, HEDIS/CAHPS improvement, and NCQA accreditation compliance for assigned health plans.
Role type
Director of Quality Management
Builds
Strategic clinical quality management and improvement programs
Domain
Healthcare / Medicaid / Quality Management
Deliverable
production ML models | product features | dashboards & analysis | research | client delivery | infrastructure | physical/clinical work
Required skills
Clinical quality management, HEDIS metrics, CAHPS surveys, NCQA accreditation, regulatory compliance, process improvement (CQI), medical record review, state contract management
Preferred skills
Behavioral health quality oversight, STARS program management, data integration with IT/analytics, matrixed environment leadership, clinical workflow familiarity
Technologies
HEDIS, CAHPS, NCQA standards, CQI methodology
Responsibilities
Develop and implement strategic clinical quality programs; Collaborate on HEDIS and CAHPS improvement action plans; Monitor and report quality measures to CMS and state agencies; Ensure compliance with accrediting requirements; Serve as a resource for process improvement plan design and evaluation
Seniority
Director, strategic leadership & cross-functional management
