Senior Director of Quality Performance Improvement Join to apply for the Senior Director of Quality Performance Improvement role at MetroPlusHealth Senior Director of Quality Performance Improvement Join to apply for the Senior Director of Quality Performance Improvement role at MetroPlusHealth This range is provided by MetroPlusHealth. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more. Base pay range $180,000.00/yr - $200,000.00/yr Empower. Unite. Care.

Increase your chances of an interview by reading the following overview of this role before making an application.

MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day.

About NYC Health + Hospitals

MetroPlus Health provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlusHealth network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlus Health has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.

Position Overview

Empower. Unite. Care.

MetroPlus Health is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day.

The Senior Director of Quality Performance Improvement will participate in developing the vision and strategic direction for the Quality Management department. This position will work with the VP of Quality Management to design and execute the organization’s quality improvement (QI) workplan and serve as a subject matter expert for HEDIS/QARR, CAHPS and HOS metrics, the NYS Department of Health (DOH) Quality Incentive Awards and CMS Star Ratings Program. The Senior Director has direction of a cross-functional team of clinical and non-clinical staff responsible for improving quality performance in preventive care, chronic care, behavioral health and member experience in all lines of business. This position will be the primary driver of the Plan’s quality-based provider engagement strategy and provide clinical oversight of quality improvement interventions for members and providers.

The Senior Director of Quality Performance Improvement is also responsible for oversight of timely and satisfactory completion of regulatory projects and programs such as the Department of Health (DOH) Performance Improvement Projects (PIP) & Quality Matrix, the Medicare & UltraCare Chronic Care Improvement Project (CCIP) and support of the Medicare & UltraCare Model of Care (MOC). Participation in product line related audits pertaining to clinical and operational quality metrics are also under the purview of this role, such as Article 44 and Special Needs Plan Model of Care audits.

Job Description

Participate in the development of the vision and strategic direction for Quality Management; works with the VP of Quality Management in the design and execution of the organization’s quality improvement (QI) workplan and serves as a HEDIS/QARR/STARS, CAHPS and HOS subject matter expert. Manage and lead cross-functional team to develop strategies, implement action plans, and oversee ongoing operational executions to meet corporate business goals for healthcare quality performance and cost containment. Drive the Plan’s quality-based provider engagement strategy to close gaps-in-care and improve risk scores. Collaborate with network providers to ensure quality improvement projects are clinically sound, care is consistent with HEDIS/QARR requirements (including coding practices) and auxiliary data streams are established, if needed. With the CAHPS Director, design and execute an organization-wide, line-of-business specific quality improvement (QI) strategy for CAHPS metrics. Drives MetroPlusHealth’s goal to provide top-tier experience to members through data-driven improvement activities and interdepartmental collaboration Assists in the identification and alignment of quality measures selected for the MetroPlus 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. Leads the QI team’s efforts to identify improvement areas, understand marketplace and member/provider behaviors, research member/provider barriers and validate them within the population, develop predictive models, perform root-cause analysis, and evaluate program effectiveness for quality performance metrics. Synthesizes multiple data streams for clinical and CAHPS metrics to identify high-risk members. Identify process improvement opportunities and provide guidance and direct oversight to automate processes, implement efficiencies, or execute needed changes. Maintain up-to- date knowledge and understanding of HEDIS/QARR/CAHPS measure technical specifications and CMS Star Rating measures, including HOS & Operational measures. Responsible for regulatory oversight of DOH Performance Improvement Projects and Matrices, the Medicare & UltraCare Chronic Care Improvement Project (CCIP) and the Medicare & UltraCare Model of Care (MOC), as well as any product line-related audits pertaining to clinical and operational quality metrics. Convene and lead work groups with external vendors and internal staff in support of quality measure improvement. Oversee evaluation of the effectiveness of interventions, dashboards, and operational performance indicators to better assess the organization’s ability to meet quality targets. Track and report on initiative progress at all appropriate levels of the organization, including Quality Management Committee and Quality Assurance and Performance Improvement Committee.

Minimum Qualifications

Master’s degree in public health, health administration, and/or clinical field. 10+ years’ experience in healthcare or managed care industry. 5+ years’ experience in a clinical setting is a plus. Strong analytical/quantitative skills. Background in statistics and/or data analysis is a plus. Extensive experience and knowledge with HEDIS/QARR/CAHPS/HOS, CMS Star Ratings. Proficiency in Microsoft Office (Word, PowerPoint, Excel, Access). Clinical license (MD, NP, RN, PharmD, LMSW/LCSW etc.) with 5+ years clinical experience preferred.

Professional Competencies

Team Building and Leadership Integrity and Trust Customer Focus Functional/Technical skills Written/Oral Communication Seniority level Seniority levelDirector Employment type Employment typeFull-time Job function Job functionQuality Assurance IndustriesHospitals and Health Care Referrals increase your chances of interviewing at MetroPlusHealth by 2x Get notified about new Senior Director Quality jobs in New York, NY . Director of Quality – Lead the Charge in Quality Excellence!System Senior Director, Regulatory Compliance-Mount Sinai Health System New York, NY $186,000.00-$270,000.00 1 week ago New York, NY $100,000.00-$120,000.00 1 week ago Senior Director- Strategic Sourcing (Medical Surgical), Corporate Supply Chain New York, NY $170,000.00-$225,000.00 3 days ago Director of Project Management – Skincare Contract Manufacturing Totowa, NJ $130,000.00-$150,000.00 1 month ago Sr. Director, Product Management, Developer Experience - Quality Assurance New York, NY $175,000.00-$200,000.00 6 days ago Director, Data Quality Sr Group Manager-C15 New York, NY $170,000.00-$300,000.00 6 days ago New York, NY $99,700.00-$122,600.00 6 hours ago New York, NY $88,000.00-$90,000.00 2 weeks ago Associate Director, Global Quality Assurance New York, NY $140,000.00-$155,000.00 3 weeks ago Director (OBH), Behavioral Health Quality Assurance New York, NY $145,000.00-$165,000.00 6 days ago Summit, NJ $214,200.00-$302,400.00 5 days ago Bronx, NY $75,000.00-$80,000.00 1 year ago Regional Director - Healthcare Operations - Provider Services Brooklyn, NY $185,000.00-$245,000.00 4 days ago Bronx, NY $100,000.00-$102,000.00 1 year ago Director of System Clinical Quality Performance - West Orange, NJ West Orange, NJ $133,924.00-$189,167.00 4 days ago Senior Director of Quality Performance Improvement New York, NY $180,000.00-$200,000.00 1 week ago Nutley, NJ $195,000.00-$256,000.00 1 week ago New York, NY $289,300.00-$321,400.00 1 week ago Brooklyn, NY $120,000.00-$135,000.00 7 months ago New York City Metropolitan Area $155,000.00-$210,000.00 1 week ago Senior Director, Global Clinical Quality Assurance Manhattan, NY $112,925.08-$133,456.92 1 day ago Westfield, NJ $115,000.00-$171,080.00 2 weeks ago Senior Director, Quality Assurance Systems Chatham, NJ $200,000.00-$300,000.00 1 week ago Director, Clinical Quality Assurance (GCP) Nutley, NJ $200,000.00-$250,000.00 1 week ago Executive Director, Head of Clinical Quality Assurance Jersey City, NJ $252,000.00-$275,500.00 1 day ago New York, NY $140,000.00-$150,000.00 2 weeks ago Director of Government Contracts & Quality Assurance New York, NY $90,000.00-$100,000.00 1 month ago System Senior Director, Regulatory Compliance-Mount Sinai Health System New York City Metropolitan Area 2 weeks ago We’re unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI.

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