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Clinical Quality (Director - Direct Hire)


Location:
Near Malaga, CA
Compensation:
BOE - Range $140K to $175K
Full benefits, Bonus eligible
Relocation:
Assistance offered
Company Background:
Our client is the nation's leading healthcare provider and offers trusted caring solutions.
Roles & Responsibilities:
Responsible for developing, coordinating, and implementing quality initiatives within a large, complex health plan.
Hires, trains, coaches, counsels, and evaluates performance of direct reports.
Supports compliance with National Committee for Quality Assurance (NCQA) standards or other accrediting bodies.
Oversees Health Employer Data Information Sets (HEDIS) reporting and the development of action plans to achieve target improvement goals.
Provides leadership for the member/provider satisfaction survey process.
Oversees the member complaint process, appeal process, and privacy compliance process across the assigned Health Plans.
Provides leadership for the development, implementation, and evaluation of Clinical Quality improvement action plans for the Central California Region.
Oversees Quality Management (QM) Scorecard reporting.
Promotes understanding, communication, and coordination of the Clinical Quality Management Program.
Establishes PDSA format interventions including QIP Quality Improvement Plans to report to CA Department of Health Care Services.
Provides leadership for implementation of Quality Management Program for the Central California Region Health Plans. Establishes annual goals and objectives.
Qualifications:
Requires a BA/BS; 10 years of experience in quality management, risk management, and/or utilization management in a managed care setting, prior management experience; or any combination of education and experience, which would provide an equivalent background.
MSN, MPH, or MPA preferred.
Quality Management experience preferred.
Health Plan or Hospital experience required.
Ajulia Executive Search is a search firm specializing in Manufacturing, Finance, IT, Legal and Pharmaceutical positions. This is a confidential search for one of our preferred clients. It is a direct hire position that includes competitive compensation and full comprehensive benefit package.

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