Vice President Of Quality Management - Hybrid

For more than 30 years, this health plan has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life. They provide the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products.

Vice President of Quality Management – Hybrid (2 days a week in the office in Manhattan and 3 days a week work from home)
Position Overview
The Vice President of Quality Management‘s primary function is to provide strategic and clinical leadership for the Quality Management Department, including Process & Quality Improvement, Health Promotion, Quality Risk Management, Quality Review Operations (HEDIS/QARR reporting), Medicare Stars, Medicare HRA Processes and QM Provider Outreach and Education. This position is responsible for oversight of the continued development and direction of the Quality Management Program and annual work plan in accordance with the policies and procedures established by the Health Plan Board of Directors’ Quality Assurance Performance Improvement Committee and the Plan’s Quality Management Committee. Activities for which the Vice President is accountable include Provider Pay for Performance Programs, Health Plan Member Rewards Program related to Quality Improvement, HEDIS/QARR reporting, Health Outcomes Survey, Quality Improvement including regulatory compliance projects such as the annual QIP, PIPs, CCIPs, NYS Quality Improvement Action Plans, etc. This position is also a key participant in the development of provider VBP arrangements, CAHPS operations and clinical measure improvement and various risk projects to improve risk scoring in various lines of business.
Job Description

• Oversees the development of the Quality Management Program Description, annual work plan and evaluation in conjunction with the Director of QI and the QM Committee.
• Actively participates in the Quality Assurance Performance Improvement Committee of the Board of Directors. Serves as a voting member of the Quality Management Committee, Utilization Management Subcommittee, Behavioral Health Joint Quality and UM Subcommittee, Appeals and Grievance Subcommittee, and Member Advisory Subcommittee.
• Oversees the interaction and reporting processes of the Quality Management Performance Improvement Committee of the Board of Directors and the Quality Management Committee and various QM Subcommittees. Prepares Board and QI Program updates as needed.
• Works with the Plan’s analytics department to work with community based primary care practices to reduce nonusers and appropriate follow up of those with chronic conditions.
• Leads the development and implementation of quality improvement initiatives and interventions and programs to address member needs, patient safety concerns and to improve the overall health of members. Leads cross-functionally to ensure QI across the organization.
• Leads the identification and alignment of quality measures selected for the Member Rewards Program, Provider Pay for Performance Program and Value-Based Programs with the regulatory quality incentive programs driving towards incentive maximization and continued improvement in member health outcomes.
• Is the principal quality liaison between Payor and Provider Quality Improvement activities.
• Interfaces with and represents Health Plan to facilities, providers, vendors, associations, and regulatory entities.
• Responsible for overseeing HEDIS/QARR annual production and reporting for all lines of business ensuring maximization of data collection (i.e., supplemental data, claims data, encounter data, medical records, etc.) captures all sources.
• Oversees the quality-of-care audits and surveys developed by the regulatory agencies and the Medical Directors.
• Leads the development of Provider Incentive Programs including but not limited to Pay for Performance and targeted/ad hoc quality incentive programs as identified throughout the year.
• Leads the development of clinically-related Member incentives via the Rewards Program. Responsible for all aspects of the Program related to clinically-oriented measures including day to day operational oversight and improvement.
• Acts as a liaison between all departments at Health Plan about Quality Improvement activities.

Minimum Qualifications

• A Master’s Degree with a specialization in Health Care, Business or related field required.
• Ten-fifteen years of senior-level related professional, technical and management experience.
• Managed Care experience strongly preferred.
• Knowledge of and experience with managed care and medical care delivery systems, UM, QM, HEDIS/QARR, CMS Stars, HOS, CAHPS, Contracting required.
• Clinical license (RN, NP, MD, etc.) with 5+ years clinical experience preferred.
• Licensure and/or Certification Required

Clinical license including but not limited to RN, NP, MD, etc.

Salary up to $275,000 + excellent benefits!!
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RCM Health Care Services’ mission is to provide opportunities for qualified candidates across medical professions. We deliver timely results and have built a reputation of trust with our clients and candidates. Since 1975, we have been providing staffing solutions to many of the finest healthcare institutions across the nation and careers for thousands of candidates. As professional career opportunity matchmakers, we follow up and follow through to help our clients and candidates to reach their career and life goals. We proudly hold the Joint Commission Gold Seal of Approval as well.