Director Market Quality Improvement(Ohio Residency Required)

Job Summary

The Director, Market Quality Improvement is responsible for directing activities to achieve defined quality goals and outcomes and improve quality performance for assigned market(s).

Essential Functions

• Executes Quality Improvement program for assigned market(s) while ensuring that quality improvement goals, outcomes, and market compliance with NCQA accreditation and quality requirements, as well as state requirements, are met
• Develops, organizes, and monitors the Quality Improvement Program, Quality Improvement Plan and QAPI processes annually, and guides their implementation
• Annually collaborates with stakeholders, reviews, incorporates recommendations, and communicates the Quality Improvement Programto appropriate stakeholders by defined time limits
• Annually evaluates the previous year’s Quality Improvement Program to collaboratively develop the work plan for the upcoming year
• Analyze potential member risk data and quality data to improve quality performance and care for members across organizational lines of business
• Oversees and/or chairs workgroups and committees, to improve quality measure outcomes in their respective market
• Collaborates with business owners across the enterprise to successfully deliver quality related standards in compliance within defined timeframes
• Ensures quality requirements are met through continual review, audit and monitoring of quality improvement / performance improvement activities
• Responds to administrative inquiries related to quality issues or audits; oversees the development of corrective action plans, as needed
• Oversees analysis, including root cause analyses, with support from identified business owners and departments; ensures data is presented and used effectively to address quality and performance improvement identified issues
• Participates in community-based initiatives related to QI program initiatives
• Establishes and maintains standards and procedures for quality report