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Form of workWe are looking for a Director of Quality & Outcomes Management - Health Plan, someone who's ready to be part of the best ranked children's hospital in Texas, and among the best in the nation. In this position, you will be responsible for planning, organizing, developing, and assessing the success of health plan quality improvement program and work plan. Responsible for coordinating the development and implementation of provider and administrative strategies for monitoring and improving outcomes by enhancing the quality of care and services rendered to members. Will provide leadership and consultation to Health Plan departments in maintaining all activities related to NCQA accreditation. Managed Care/ HealthPlan experience (highly preferred).
Skills & Requirements
- Being fully vaccinated against COVID-19, including any booster dose(s) of the COVID-19 vaccine recommended by the Centers for Disease Control when eligible, is required for all employees unless approved for a medical or religious exemption.
- Required bachelor's degree Nursing
- Preferred master's Degre
- Required RN - Lic-Registered Nurses by the Texas Board of Nursing or Nursing Licensure Compact
- Preferred CERTPHQ - Cert Profess in Healthcare & Qual by the National Association for Healthcare Quality
- Required 4 years of experience in quality improvement, medical management; including two years of management/leadership experience
Job Duties & Responsibilities
- Continuously evaluates and updates the HP Quality Improvement Program and Workplan based upon data-driven assessments of the health needs/outcomes of members, accreditation, regulatory and contractual requirements.
- Provides oversight for maintenance of Quality Dashboards, including HEDIS Measure performance, for Executive Leadership.
- Provides organizational leadership for all activities related to the on-going National Committee for Quality Assurance accreditation.
- Coordinates the Quality-of-Care report processes to meet regulatory and contract requirements.
- Oversees quality management staff and coordinates departmental functions with Care Management, Claims Administration, Network Development, Information Systems, Member Services, Finance, and the Integrated Delivery System.
- Provides leadership for multiple essential committees in the health plan infrastructure.
- Coordinates the delegation oversight processes for selected vended services including vision and dental; ensuring oversight complies with all accrediting, regulatory and contractual requirements.
- Oversees health plan credentialing functions, including delegated credentialing for all delegated entities, ensuring oversight complies with all accrediting, regulatory and contractual requirements.
- Oversees regulatory and other survey assessments of the accessibility, quality of care and service for health plan members.
- Leads the ongoing professional monitoring, documentation, and evaluation of both the annual Quality Assessment and Performance Improvement Plan and the annual HHSC Performance Improvement Plans to assure progress to goals and compliance with regulatory requirements.
Founded in 1996, Texas Children's Health Plan is the nation's first health maintenance organization (HMO) created just for children. We provide STAR/Medicaid and Children's Health Insurance Program (CHIP) to pregnant women, teens, children and adults in Houston and surrounding areas. Currently, the Health Plan has more than 375,000 members who receive care from our network of more than 1,100 primary care physicians, 3,200 specialists, and 70 hospitals. Texas Children's Health Plan is also the largest combined STAR/CHIP Managed Care Organization in the Harris County service area.
To join our community of 14,000+ dedicated team members, visit texaschildrenspeople.org for career opportunities. You can also learn more about our amazing culture at infinitepassion.org.
Texas Children's is proud to be an equal opportunity employer. All applicants and employees are considered and evaluated for positions at Texas Children's without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, gender identity, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.
