Director, Statewide Quality California Medicaid

Director, Statewide Quality California Medicaid

This is a statewide position that will oversee all quality and NCQA activities for the CA Medicaid Business, reporting to the Chief Medical Officer. Primary duties may include, but are not limited to:

• Provides leadership for implementation of The Quality Management Program for the assigned California Health Plan.
• Establishes annual goals and objectives.
• Promotes understanding, communication, and coordination of the Clinical Quality Management Program.
• Oversees Quality Management (QM) Scorecard reporting.
• Provides leadership for the development, implementation, and evaluation of Clinical Quality improvement action plans.
• Provides leadership for the member/provider satisfaction survey process.
• Oversees Health Employer Data Information Sets (HEDIS) reporting and the development of action plans to achieve target improvement goals.
• Supports the Health Plans External Quality Review Organization (EQRO) state audit processes.
• Participates in the Quality Improvement Council (QIC).
• Supports compliance with National Committee for Quality Assurance (NCQA) standards or other accrediting bodies.
• Hires, trains, coaches, counsels, and evaluates performance of direct reports.

Qualifications

• Requires a BA/BS.
• 10 years of experience in quality management.
• HEDIS, and health plan experience preferred.
• RN, MBA, MPH, or additional Quality certifications preferred.

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