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Senior Director, Quality Improvement - Florida Job Details

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Company:  WellCare Health Plans, Inc.
Job Code:  1200197
Categories:  For-Profit Senior Services
Job Role:  Maintenance / Facilities Mgmt / Building & Grounds
Region/Province:  Florida (FL)
City:  FL-Tampa
Job Description:  !*!About WellCare: WellCare Health Plans, Inc. provides managed care services targeted to government-sponsored health care programs, focusing on Medicaid and Medicare. Headquartered in Tampa, Florida, WellCare offers a variety of health plans for families, children, and the aged, blind, and disabled, as well as prescription drug plans. For more information about WellCare, please visit the Company's website at www.wellcare.com.

Our History: Founded in 1985 with three associates, WellCare grew to more than 800 associates and 467,000 members in Florida, New York and Connecticut by 2002. In 2004, the company acquired Harmony to enter the Midwest and became publicly traded. By 2006, WellCare served 2.2 million members as it became a national prescription drug plan provider and the largest Medicaid plan in Georgia. WellCare expanded its services when it began offering Medicaid managed care plans in Ohio and Missouri in 2007, and Medicare managed care plans in Texas and New Jersey in 2008. Additional growth followed when the company was chosen to serve Hawaii's Medicaid program for the aged, blind or disabled in 2009, and in 2011 when it was selected to serve Kentucky's Medicaid program. Today, WellCare has more than 3,900 associates and approximately 2.4 million members nationwide.

EOE: All qualified applicants shall receive consideration for employment without regard to race, color, religion, sex, age forty (40) and over, disability, veteran status, or national origin.

The Senior Director, Quality Improvement plans, develops and directs the Quality Improvement functions.  The incumbent provides leadership necessary to achieve national best practice performance levels in quality improvement while implementing evidence based medicine/practices.  In addition, the Senior Director ensures that the quality of healthcare services rendered meets or exceeds professionally recognized community standards, interfaces with a diverse range of clinical and administrative professionals, resolves sometimes-complex policy and service issues within the group and directs data analytic and reporting activities that are prescribed by customers and regulators in a multi-market environment.  Incumbent ensures compliance with state, federal and accreditation requirements.

 


Reports to: VP, Quality Improvement

Position Supports: Florida LOB


 

Essential Functions:


  • Develops and implements the quality improvement plan within regional markets in accordance with the mission and strategic goals of the organization, federal and state laws and regulations, and accreditation standards.

  • Establishes professional relationships with state, stakeholders and community agencies to facilitate quality process internally and externally.

  • Develops and implements systems, policies, and procedures for the identification, collection, and analysis of performance measurement data.

  • Analyzes, updates, and modifies standard operating procedures and processes to continually improve QI Department services/operations.

  • Assists in strategizing and facilitating various committee structures and functions to best address the QI process and oversees Quality Committees.

  • Oversight and interface internally and externally with pay for performance programs and initiatives

  • Coordinates and completes all QI activities required to meet national accreditation and regulatory performance improvement initiatives.

  • Supervises member outreach coordinators with overall responsibility for providing support for clinical quality initiatives and regulatory/contractual requirements. Support includes telephonic and in-person outreach to members who are identified as requiring outreach services. In addition, to provide assistance to clinical compliance staff with member education classes, quality management, and Health Promotion initiatives and performance data collection and recording.

  • Collects and summarizes regional market performance data, identifies opportunities for improvement, and presents findings quarterly to the Performance Improvement Committee

  • Develops strategies for special program participation and Quality Improvement. Develops systems for close coordination of QI related functions with departments whose activities are directly a part of the QI Program, including Credentialing.

  • Supervises QI Specialists in the implementation of performance initiatives to drive HEDIS performance and contract compliance quality performance.

  • Communicates new state, federal and third party regulations and requirements to the staff.

  • Facilitates strategic and tactical planning for the quality improvement program, including needs assessments, evaluations, root cause analysis and interventions.

  • Collaborates with Health Services, Operations, and Information Technology departments to ensure full integration of quality improvement reporting for contract and accreditation compliance

  • Participates in site visit preparation and execution by regulatory and accreditation agencies (state agencies,URAC,NCQA,CMS,AAAHC,EQRO)

  • Leads, facilitates, and advises internal quality improvement teams

  • Actively participates on, or facilitates committees such as: Quality Improvement, Utilization Management, Patient

  • Safety, and Risk Management

  • Responsible for monitoring and evaluating staff performance.

  • Performs other duties as assigned



Education:  A Bachelor's Degree in Healthcare, Nursing, Health Administration or related field.  Master's Degree in Healthcare or Public Health, preferred.                                                         

 

Experience: 


  • 10 years of quality improvement experience

  • 5 years in Managed Healthcare

  • Excellent knowledge of JCAHO, URAC, AAAHC and NCQA standards

  • 4 years with Medicaid experience

  • 5 years management experience


Licenses/Certifications:  R.N. with active licensure. Certification in Healthcare Quality by the Healthcare Quality Certification Board, or equivalent (preferred).    

 

Special Skills (e.g. 2nd language): 


  • Excellent understanding of accreditation, federal and state regulations/requirements

  • Excellent verbal and written communication skills

  • Strong analytical and problem solving skills

  • Ability to communicate effectively with people with varying levels of education

  • Ability to multitask in a fast paced environment


 Technical Skills/Requirements:  Proficient in Microsoft Office such as Excel, Word, Visio, PowerPoint and Outlook. 

Post Date:  04/05/2012

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