Location Address:
9521 San Mateo NEAlbuquerque, NM 87113-2237
Summary:
The Vice President of Quality provides leadership for all activities relating to the development and management of the Plan's quality improvement and accreditation activities including NCQA, contractual and regulatory quality requirements and measures for all lines of business including but not limited to HEDIS/Performance Improvement, clinical quality programs, clinical vendor management (excluding Pharmacy Benefit Manager). This role also develops and oversees strategies, policies and processes to ensure implementation of programmatic initiatives related to these areas with both internal and external stakeholders.
Work Arrangement:
• Remote: Open to applicants in the United States, excluding CA, IL, ND, NY, WA, and WY.
• Hybrid: For individuals within 60 miles of Albuquerque, in-office presence is required Tuesday through Thursday.
Job Description:
- Responsible for executing on operational strategies and programs using complex analytics and reporting to support Medicare Star Ratings, HEDIS, and Quality Intervention Programs. Responsible for the annual HEDIS submission, PHP Medicare Star Program Ratings, NCQA accreditation, and regulatory and contractual compliance.
- Directs the activities for Performance Improvement intervention programs, HEDIS/Star analytics and reporting and abstraction activities. This key position works in collaboration with a variety of PHP/PHS entities, departments, administration, and leadership bodies to ensure organizational improvement efforts align with accrediting, licensing, and legal requirements.
- Designs, implements and leads the Plan's continuous quality improvement infrastructure.
- Acts as an internal consultant and resource to all levels of the organization relative to CQI processes and standards.
- Works in collaboration with the broader PHS system to identify opportunities, implement innovations and evaluate outcomes
- Oversees the development and execution of Stars strategy in conjunction with key business partners
- Responsible the development and execution of the organizations Medicare and Medicaid Sustainability and strategy in determining an approach to securing and maintaining an annual Medicare Advantage Star Rating of 4.0 or higher, meeting 100% of Medicaid Performance Measure targets, and ensuring the maintenance of NCQA health plan accreditation for all lines of business.
- Leads all Plan activities for National Committee for Quality Assurance (NCQA) re-accreditation.
- Responsible for the ongoing administrative, clinical, fiscal and programmatic interaction with NCQA. Communicates with NCQA as needed to ensure the Plan is informed of all events and circumstances that affect the initial and on-going achievement of NCQA accreditation.
- Is responsible for overall Utilization Program Compliance as it pertains to accreditation obligations.
- Oversees quality of care studies (based on targeted areas for quality management and quality improvement). This includes the following: analyzes data, performs root cause analysis, facilitates plans for improvement, provides technical support to Plan managers, and conducts re-measurement activities to assess performance improvement.
- Monitors quality performance indicators; prepares reports for quality oversight committees; develops vehicles to communicate performance to providers; and identifies clinical and administrative concerns for further investigation and analysis.
- Develops and manages communications with providers, government and accreditation organizations with respect to results of quality management studies, including oversight of remedial action as required.
- Directs the supervision of subordinate staff to include hiring, work allocation, scheduling, training and professional development, problem resolution, performance evaluation and related supervisory activities. Maintains budgetary responsibility for responsible departments.
- Directly manages 5-15 staff and indirectly oversees up to 40 staff.
Additional Job Description:
Education
- Bachelor's degree in Health Care Administration, Public Health, Nursing, or related field or the equivalent combination of training and experience is required.
- Master's degree in related field strongly preferred.
- Licensure, Certification, and Conditions of Employment
- Active clinical licensure required.
- Active clinical licensure as a Registered Nurse strongly preferred.
- Pre-employment background check
- CPHQ certification strongly preferred.
Experience
- 10+ years progressively responsible experience in leading Quality Improvement Programs, which includes supervision of staff and budget management, is required.
- Comprehensive knowledge of Medicaid regulations, guidelines and standards is required.
- Comprehensive knowledge of accreditation organizations such as NCQA is required.
- Experience within a managed care organization is strongly preferred.
- Previous experience in designing and leading an accreditation process is strongly preferred.
Benefits
Benefits are effective day-one (for .45 FTE and above) and include:
- Competitive salaries
- Full medical, dental and vision insurance
- Flexible spending accounts (FSAs)
- Free wellness programs
- Paid time off (PTO)
- Retirement plans, including matching employer contributions
- Continuing education and career development opportunities
- Life insurance and short/long term disability programs
About Us
Presbyterian Healthcare Services is a locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, it is the state's largest private employer with approximately 11,000 employees.
Presbyterian's story is really the story of the remarkable people who have chosen to work here. Starting with Reverend Cooper who began our journey in 1908, the hard work of thousands of physicians, employees, board members, and other volunteers brought Presbyterian from a tiny tuberculosis sanatorium to a statewide healthcare system, serving more than 700,000 New Mexicans.
We are part of New Mexico's history - and committed to its future. That is why we will continue to work just as hard and care just as deeply to serve New Mexico for years to come.
About New Mexico
New Mexico's unique blend of Spanish, Mexican and Native American influences contribute to a culturally rich lifestyle. Add in Albuquerque's International Balloon Fiesta, Los Alamos' nuclear scientists, Roswell's visitors from outer space, and Santa Fe's artists, and you get an eclectic mix of people, places and experiences that make this state great.
Cities in New Mexico are continually ranked among the nation's best places to work and live by Forbes magazine, Kiplinger's Personal Finance, and other corporate and government relocation managers like Worldwide ERC.
New Mexico offers endless recreational opportunities to explore, and enjoy an active lifestyle. Venture off the beaten path, challenge your body in the elements, or open yourself up to the expansive sky. From hiking, golfing and biking to skiing, snowboarding and boating, it's all available among our beautiful wonders of the west.
AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.
