Exec. Director, Medicaid HealthCare QualityPrimary Location: New Albany, OH
Additional Locations: OH-New Albany Apply
Acts as an Advocate for, and supports, the Medicaid business by serving as a quality champion through measuring and monitoring the quality and effectiveness of work processes in claim processing and/or customer service that impact customer satisfaction, medical cost management, and operational efficiency. Consult and/or work cross functionally to influence and promote change to continually deliver quality service to our internal and external customers.
- Sets the direction of the strategic business plan for the Medicaid quality strategy and translates into vision for staff/others.
- Ensures the implementation and ongoing execution of the Medicaid Health Care Quality Management Program to support business, regulatory and accreditation requirements, and improve HEDIS results.
- Fosters a culture of quality using innovation, integration and information to support Medicaid revenue and membership growth while achieving business goals.
- Establishs strategic relationships with Medicaid executive leadership throughout the organization to develop and remove barriers, if needed, to implement program strategies that meet business, regulatory and accreditation requirements.
- As a Medicaid business leader, influences all stake holders, internal and external, to support key projects/programs to ensure positive outcomes that deliver on results.
- Builds strong high performing leadership teams through training, stretch assignments, coaching, performance management and other development techniques.
- Maintains a working knowledge of legislative changes that may potentially affect Medicaid quality and care management practices and standards.
- Completes regular data analysis to identify trends that that identify gaps in care for the Medicaid populations.
- 8-10 years clinical/managed care/health care industry experience
- Previous quality improvement and management experience in a managed care organization required
- Thorough knowledge of NCQA and/or HEDIS management
- Multiple years proven leadership experience setting strategic direction and influencing change that resulted in quantifiable positive outcomes
- Proven history managing complex projects and or programs that resulted in cost savings
- Experience managing large budgets
- Demonstrated negotiation skills
- Effective and advanced organizational, decision-making, and analytical skills required
- Excellent verbal and written communication skills.
- Proficient computer skills and knowledge of Microsoft Word, Excel and Access
- Ability to work in a demanding environment
- Demonstrated ability to anticipate customer needs and requirements
- MD or DO preferred
- Master’s degree preferred
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