Job Information
Highmark Health Director Provider Quality Outcomes in Oklahoma City, Oklahoma
Company :
Highmark Inc.
Job Description :
JOB SUMMARY
This job directs the development, implementation, execution and continuous improvement of the STARs Provider field facing strategy to ensure the Organization meets its STARS targets as applicable in all service regions. Responsibilities include but are not limited to the overall field facing STARs Provider Strategy, supporting and developing technology and data strategies to support STARs performance, and developing provider incentive programs. Works collaboratively with multiple stakeholders, vendors and various cross-functional teams, locations and departments to improve Stars and/or Quality Rating outcomes for Medicare Advantage across footprint. Designs, implements and executes strategies and works with cross-functional clinical, pharmaceutical, operational, IT and Performance Management improvement teams to ensure overall goals of the Organization are met and to optimize outcomes. Collaborates with the company's Medicare Advantage matrixed teams to improve processes, procedures and best practices. The incumbent provides regular status, program health and escalating cross-portfolio dependencies, project risks and items for management attention to the executive leadership team.
ESSENTIAL RESPONSIBILITIES
Perform management responsibilities to include, but are not limited to: involved in hiring and termination decisions, coaching and development, rewards and recognition, performance management and staff productivity.Plan, organize, staff, direct and control the day-to-day operations of the department; develop and implement policies and programs as necessary; may have budgetary responsibility and authority.
Develop, implement and execute, the Provider STARs quality strategy, support/develop technology and data strategies to support STARs performance, and provider incentive programs in partnership with senior leadership for the Medicare Advantage Quality Consultants. Partner to develop, implement and monitor interventions to improve the clinical STARS measures. Lead/participate in both departmental and interdepartmental work groups to continually enhance the delivery of provider STARs strategy and proactively respond to changing client and market expectations.
Implement quality strategic initiatives with development of action plans that include clarifying the goals/aims and metrics, collaborating with team members to identify ideas/solutions, applying change methodologies, coordinating activities designed to reinforce and embed best-practice changes and next steps to create continuous improvement.
Direct STARs management to develop interventions and direct provider-based and internal Organization committees to advance member health and service outcomes. This involves action plan development, timelines, large-scale complex multi-pronged interventions, and communication strategies for complex issues with large impact on the organization and its members.
Provide direction and supervises direct reports to ensure that efforts are consistent and complementary.
Participate on relevant STARs quality committees Quality, Safety, and Value Council. Prepare materials and deliver information related to health plan quality.
Other duties as assigned or requested.
EXPERIENCE
Required
5 years of management or leadership role
7 years of Health Care Quality or other relevant experience
SKILLS
Medicare Advantage - Expertise with CMS STARS Program
Quality Programs Implementation and Improvement
Written & Oral Presentation Skills
Influence and Persuasion
Continuous Improvement/Process Improvement
Analytical and Logical Reasoning/Thinking
Regulatory Compliance
Communication Skills
Leadership/Leading Change
EDUCATION
Required
- Bachelor’s degree or relevant experience and/or education as determined by the company in lieu of bachelor's degree.
Preferred
- Masters
LICENSES or CERTIFICATIONS
Required
- None
Preferred
- None
Language (Other than English):
None
Travel Requirement:
0% - 25%
PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS
Position Type
Office- or Remote-based
Teaches / trains others
Occasionally
Travel from the office to various work sites or from site-to-site
Rarely
Works primarily out-of-the office selling products/services (sales employees)
Never
Physical work site required
No
Lifting: up to 10 pounds
Constantly
Lifting: 10 to 25 pounds
Occasionally
Lifting: 25 to 50 pounds
Rarely
Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.
Compliance Requirement : This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.
As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy.
Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.
Pay Range Minimum:
$108,000.00
Pay Range Maximum:
$199,800.00
Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, age, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, age, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.
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Req ID: J249105
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