Quality Improvement Director - Healthcare jobs in Stockton, CA

The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change.

What You Will Be Doing:

Under administrative direction the Executive Director Quality Improvement and Health Equity (CHEO) is responsible for providing strategic direction of the quality functions consistent with contractual and regulatory requirements, and HPSJ strategies and objectives. The Executive Director is also responsible for providing strategic direction for HPSJ’s health equity programs and collaborates with internal and external stakeholders to design and oversee the implementation of programs and initiatives that promote health equity and reduce health disparities. Work is varied and complex and requires a moderate to high degree of discretion and independent judgment.

Supervises

• Staff in quality improvement, credentialing, grievances and appeals and accreditation.
• Health Equity supervisory and staff level positions and Cultural & Linguistics

Our Vision:

Continuously improve the health of our community.

Our Mission:

We provide healthcare value and advance wellness through community partnerships.

Essential Functions:

• Develops operational objectives and plans; ensures the development and implementation of associated business plans and tactics for Quality & Health Equity.
• Anticipates the need for and develops and implements relevant and effective programs, policies, procedures and processes for quality, credentialing, peer review, grievances and appeals and Health Equity based on regulatory requirements, opportunities, issues, and trends.
• Assists Chief Medical Officer and Medical Director in identifying medical service issues that have an impact on plan benefits and their administration; assists managers in resolving grievances, appeals, quality and other health equity related issues.
• Collaborates across medical management and other departments to ensure that the Quality program meets or exceeds NCQA and regulatory standards.
• Collaborates with internal and external stakeholders to develop programs that increase awareness and provide educational opportunities to providers and members regarding HPSJ’s Quality Improvement and Health Equity Transformation Program goals and activities.
• Collaborates with Provider Services and other internal and external stakeholders to ensure effective implementation of provider and member interventions to improve quality and HEDIS measures including Health Equity measures and maintains compliance with FSR/MRR.
• Provides leadership in the design and implementation of strategies and programs to ensure health equity is prioritized and addressed both with internal health plan functions and external and community partnerships.
• Works collaboratively with all departments across the organization to achieve health equity goals established by NCQA and DHCS, and partners with the Quality team to ensure that the QIHETP program is implemented and monitored to meet or exceed DHCS/DMHC & NCQA requirements.
• Ensures organizational policies, procedures, and programs consider health inequities and are designed to promote health equity where possible, including but not limited to: Marketing strategies, medical and other health services policies, member and provider outreach, community advisory committee, quality improvement activities, including delivery system reforms, grievances and appeals, and utilization management.
• Develops and implements or oversees the development and implementation of policies and procedures aimed at improving health equity and reducing health disparities.
• Engages and collaborates with HPSJ staff, subcontractors, downstream subcontractors, network providers, community-based organizations, local health departments, behavioral health, social services, child welfare systems, members, NCQA and DHCS regulatory officials and other stakeholders in health equity efforts and initiatives. This includes in person meeting attendance within HPSJ service area.
• Implements strategies designed to identify and address root causes of health inequities including but not limited to systemic racism, social drivers of health and infrastructure barriers for HPSJ members and providers.
• Develops or oversees the development of targeted interventions designed to eliminate health inequities.
• Develops quantifiable metrics that can track and evaluate the results of the targeted interventions designed to eliminate health inequities.
• In collaboration with Compliance, ensures staff, subcontractor, downstream subcontractor and network provider staff receive mandatory diversity, equity and inclusion training, as specified in the DHCS contract; includes reviewing training materials to ensure materials are up to date with current standards or practice and maintaining records of training completion.
• Serves as a lead and/or subject matter expert on the Quality Improvement and Health Equity Transformation Committees and in the development of a Health Equity Annual Report.
• Serves as a representative and spokesperson for HPSJ in support of Health Equity with key county partners.
• Participates in State and industry work groups such as DHCS, DMHC, CHCF, NCQA, ACAP and CAHP to expand HPSJ’s influence on benefit design, regulations, and policy direction.
• Conducts or oversees the preparation, implementation, and corrective action plans for internal and external audit activities to ensure practices adhere to adopted guidelines, NCQA requirements, regulatory guidelines and HPSJ criteria.
• Develops or oversees the development of relevant, timely and accurate internal and external quality and health equity reports, advising leadership as appropriate.
• Develops and manages department budgets; implements appropriate interventions.
• Develops, implements, and maintains appropriate and required records, documents, policies, and procedures; collaborates with internal and external stakeholders to ensure the collection, storage and retrieval of relevant data and information.
• Leads or participates in internal and external committees.
• Develops and maintains relationships with the regulatory bodies such as DHCS and the DMHC serving as the contact for quality and health equity activities and inquiries.
• Promotes and maintains and ensures that direct reports promote and maintain an environment that supports HPSJ’s strategy, vision, mission, and values.
• Hires, develops, and retains, and ensures that subordinate managers hire, develop and retain competent staff.

What You Have:

Education, Experience, & Licensure

Required

• Medical degree from an accredited medical school; and
• Satisfactory completion of an American Council of Graduate Medical Education accredited residency program; and
• Unrestricted, active license to practice medicine in the State of California, issued by the Medical Board of California, which meets HPSJ’s credentialing and recredentialing requirements; and
• Certification by a specialty board recognized by the American Medical Association or the American Osteopathic Association; and
• Satisfactory completion of an American Council of Graduate Medical Education accredited residency program; and
• At least 5 years of management experience; and
• At least five years clinical experience in the practice of medicine in fields related to a managed care setting; and
• At least five years clinical experience in the practice of medicine with MediCal and/or Medicare populations; and
• At least 5 years of experience in developing & Implementing Quality, Population Health Programs in a managed care setting in a senior leadership role.
• At least three years of experience developing and/or implementing health care diversity initiatives that address health equity and health disparities; and
• Certificated in Health Equity and Diversity, Health Disparities and Health Inequality or other certification that meets California and/or federal requirements or within one year of hire; and
• Valid California driver license and reliable transportation or, the ability to obtain transportation on demand in the counties served by HPSJ if prohibited from getting a driver license due to a medically documented disability.

Preferred

Combination 2:

Required

• Master’s Degree in a clinical discipline; and
• At least five years management experience in a managed care setting; and
• At least five years clinical experience with MediCal and/or Medicare populations; and
• At least five years of experience leading, developing and/or implementing Quality or Population Health Programs
• At least three years of experience in developing and implementing health care diversity initiatives that address health equity and health disparities; and
• State of California, unrestricted, active license within clinical discipline.
• Certificated in Health Equity and Diversity, Health Disparities and Health Inequality or other certification that meets California and/or federal requirements or within one year of hire; and
• Valid California driver license and reliable transportation or, the ability to obtain transportation on demand in the counties served by HPSJ if prohibited from getting a driver license due to a medically documented disability.

Preferred

• Quality experience with strategic vision to continue to optimize design of both quality Improvement and health equity improvement programs.
• Experience collaborating with diverse groups of stakeholders, convening and negotiation to blend diverse opinions, to achieve ambitious outcomes, an established track record of leading change management efforts, and an ability to influence others especially when no direct reporting relationship exists.

Combination 3:

Required

• Masters or Doctorate in Public Health; and
• At least five years of management experience in a managed care setting; and
• At least five years of experience with Medi-Cal and/or Medicare populations; and
• At least three years of experience developing and/or implementing health care diversity initiatives that address health equity and health disparities; and
• Certificated in Health Equity and Diversity, Health Disparities and Health Inequality or other certification that meets California and/or federal requirements or within one year of hire; and
• Valid California driver license and reliable transportation or, the ability to obtain transportation on demand in the counties served by HPSJ if prohibited from getting a driver license due to a medically documented disability.

Preferred

• Experience collaborating with diverse groups of stakeholders, convening and negotiation to blend diverse opinions, to achieve ambitious outcomes, an established track record of leading change management efforts, and an ability to influence others especially when no direct reporting relationship exists.
• Quality experience with strategic vision to continue to optimize design of health equity improvement programs.
• disability.

What You Bring:

Knowledge, Skills, Abilities and Competencies

• In-depth knowledge of health equity and diversity principles, concepts and best practices.
• Strong knowledge of general medical policy benefits and exclusions.
• Strong knowledge of managed care regulatory guidelines, especially California Medicaid experience
• Strategic mindset: Sees ahead to future possibilities and translates them into breakthrough strategies; identifies, plans, leads and executes to meet changing organizational and community needs, and regulatory requirements.
• Cultivates innovation: Creates new and better ways for the organization to be successful.
• Drives results: Consistently achieves results, even under tough circumstances.
• Drives engagement: Creates a climate where people are motivated to do their best to help the organization achieve its objectives.
• Drives vision and purpose: Paints a compelling picture of the vision and strategy that motivates others to action.
• Courage: Steps up to address difficult issues, says what needs to be said.
• Nimble learning: Actively learns through experimentation when tackling new problems, uses both successes and failures as learning fodder.
• Situational adaptability: Adapts approach and demeanor in real time to match the shifting demands of different situations.
• Resourcefulness: Secures and deploys resources effectively and efficiently; organizes people and resources to solve problems and identify opportunities.
• Plans and aligns: Plans and prioritizes work for self and others to meet commitments aligned with organization goals.
• Ensures accountability: Holds self and others accountable to meet commitments.
• Ability to collaborate with and lead diverse groups of stakeholders to achieve Quality, diversity, equity and inclusion goals.
• Strong collaboration skills with demonstrated ability to create and foster a collaborative work environment, and maintain effective, high-performance teams.
• Evidence of ability to provide leadership in Quality, diversity, equity and inclusion in a health care and other settings, and an interest and involvement in the affairs of the health care community.
• Strong knowledge of and ability to identify, implement, monitor and analyze relevant metrics models as they relate to Quality and health equity, with ability to implement effective interventions based on results.
• Very strong interpersonal skills with the ability to initiate establish and maintain effective working relationships with diverse individuals and groups both inside and outside of HPSJ.
• Very strong oral and written communication skills with the ability to communicate professionally, effectively, and persuasively to diverse individuals and groups inside and outside of HPSJ; includes the ability to effectively explain complex information.
• Strong presentation and public speaking skills, including the ability to tailor presentations to a specific audience, and address and interact with large groups.
• Promotes and maintains and ensures that direct reports promote and maintain an environment that supports HPSJ’s strategy, vision, mission and values.
• Intermediate skills in Word, Excel and Outlook, including the ability to develop spreadsheets, formulas, and create tables and graphs.
• Ability to supervise staff in a manner that maximizes employee performance and business results, which includes very strong coaching/counseling skills and ability to function as a mentor.
• Ability to speak and be understood in English.
• Ability to handle confidential information with appropriate discretion.

Preferred

• Knowledge of the economic or healthcare issues, or issues affecting the underserved in California or San Joaquin County and/or surrounding areas.
• Knowledge of Medi-Cal and/or Medicare programs.
• Basic knowledge of the principles and practices of managed care.
• Deep content knowledge of the diversity, equity, and inclusiveness research base and best practices for organizations striving to become more diverse, equitable, and inclusive.
• Ability to develop and monitor indicators of organizational culture and engage employees and senior leadership to create organizational change.

What You Will Get:

HPSJ Perks:

• Competitive salary
• Robust and affordable health/dental/vision with choices in providers
• Generous paid time off (starting at 3 weeks of PTO, 4 paid floating holidays including employee’s birthday, and 9 paid holidays)
• CalPERS retirement pension program, automatic employer-paid retirements contributions, in addition to voluntary defined contribution plan
• Two flexible spending accounts (FSAs)
• Employer-Paid Term Life and AD&D Insurance
• Employer-Paid Disability Insurance
• Employer-Paid Life Assistance Program
• Health Advocacy
• Supplemental medical, legal, identity theft protection
• Access to exclusive discount mall
• Education and training reimbursement in addition to employer-paid elective learning courses.
• A chance to work for an organization that is mission-driven – our members and community are at the core of everything we do.
• A shorter commute – if you’re commuting from the Central Valley to the Bay Area.
• Visibility and variety – you have a chance to work with people at all levels of the organization, and work on diverse projects.

We are an equal opportunity employer and diversity is one of our core values. We believe that differences including race, ethnicity, gender, sexual orientation and other characteristics, will help us create a strong organization that is sensitive to the needs of those we serve. Employment decisions are made on the basis of qualifications and merit.

HPSJ provides equal employment opportunities to employees and applicants for employment and prohibits discrimination based on color, race, gender (including gender identity and gender expression), religion (including religious dress and grooming practices), marital status, registered domestic partner status, age, national origin (including language use) or ancestry, physical or mental disability, medical condition (including cancer and genetic characteristics), sex (including pregnancy, childbirth, breastfeeding or related medical condition), genetic information, sexual orientation, military or veteran status, political affiliation or any other characteristic made unlawful by applicable Federal, State or local laws. It also prohibits unlawful discrimination based on the perception that anyone has these characteristics, or is associated with anyone who has or is perceived to have these characteristics.

Important Notice: This job description is not a contract between HPSJ and the employee performing the job. The duties listed in the job description may be changed at the discretion of HPSJ, and HPSJ may request the employee to perform duties that are not listed on the job description.