Vice President, Quality & Process Improvement
Posted on: 27 Jun 2021
West Allis, WI
Job Description
Position Purpose:
Develop and oversee quality improvement programs and strategies for the business unit. Assist in the development and application of the business unit’s strategic mission and vision. Identify and champion the selection of process improvement activities across the enterprise.
Responsible for driving performance improvement for HEDIS, Stars, State Contract Quality & Pay for Performance/Withhold, Marketplace QRS and Medicare Quality metrics and processes and other quality improvement opportunities as needed.
Develop infrastructure and processes for management of activities related to National Committee for Quality Assurance (NCQA) Accreditation and Healthcare Effectiveness Data and Information Set (HEDIS) performance ensuring highest level of accreditation
Oversee the development and implementation of enterprise wide and market specific process improvement programs
Review and present results of quality interventions for clinical and operational performance improvements and identify organizational risks to executive management
Develop and ensure consistent, reliable and valid application of data collection and analysis for priority performance measures, including HEDIS, pay for performance and contractual performance measures
Review and analyze cost benefit and return on investment analyses for organizational resource allocation and recommend action plans
Responsible for building relationship and positioning MHS as the “go to” source for state of the art MCE Quality Metrics.
Education/Experience:
Bachelor's degree in healthcare or related clinical field. Master's in Business Administration preferred. 10+ years of healthcare operations experience including, quality and process improvement experience. Experience with NCQA accreditation preparation and auditing, including the analysis of HEDIS performance measures.
WellCare
Tampa, FL
WellCare Health Plans, Inc. provides government-sponsored managed care services. The company operates in three segments: Medicaid Health Plans, Medicare Health Plans, and Medicare Prescription Drug Plans (PDPs). The Medicaid Health Plans segment offers plans for beneficiaries of temporary assistance for needy families, supplemental security income, and aged blind and disabled residents; and other state-based programs, such as children's health insurance programs and long-term services and supports programs for qualifying families who are not eligible for Medicaid.
The Medicare Health Plans segment provides Medicare, a federal program that provides eligible persons aged 65 and over, as well as some disabled persons with a range of hospital, medical, and prescription drug benefits; Medicare Advantage, a Medicare’s managed care alternative to the original Medicare program, which offers individuals standard Medicare benefits directly through Centers for Medicare & Medicaid Services; and coordinated care plans that are administered through health maintenance organizations and require members to seek health care services and select a primary care physician from a network of health care providers.
The Medicare PDPs segment provides Medicare part D PDP plans to Medicare-eligible beneficiaries. Its PDP plans offer national in-network prescription drug coverage, including a preferred pharmacy network. As of December 31, 2018, the company served approximately 5.5 million members in the United States. WellCare Health Plans, Inc. was founded in 1985 and is headquartered in Tampa, Florida.
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IndustryHealthcare
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No. of Employees12, 000
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Website
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Jobs Posted917
