Director, Value Performance
Location
McLean, VA | United States
Job description
The Director, Value Performance is accountable for the vision and strategic direction for all clinical operations across the organization. They serve as primary client facing liaison to facilitate the development of clinical operational processes related to new and existing client implementation.
This is a fully remote position with preference to work EST or CST hours.
- Provide leadership and support in establishing and directing the Clinical Operations Value Performance programs to include HEDIS chart abstraction, primary source validation, and call center activities for medication adherence and other clinical HEDIS / Value Performance Measures.
- Develop and maintain policies and procedures that support the organization’s initiatives that meet State and Federal requirements.
- Collaborate with operations to execute the implementation of the clinical quality data initiatives and strategies as defined by leadership and coordinate the reporting on all initiatives with appropriate committees.
- Provide expertise to the training department on HEDIS / Value Performance Measures and tools that support collection of and communication to the enterprise.
- Develop HEDIS / Value Performance Measures and provider engagement strategies.
- Work with leadership to provide HEDIS / Value Performance Measures reporting and to develop strategic direction.
- Facilitate, integrate, and/or coordinate the implementation and evaluation of identified quality improvement activities.
- Promote understanding, communication, and coordination of all HEDIS / Value Performance Measures improvement program components.
- Participate in requested evaluation and health plan audits.
- Maintain current knowledge of regulatory requirements associated with HEDIS / Value Performance Measures.
- Oversee HEDIS / Value Performance Measures data submission process to all contracted health plans and ensure accuracy and timeliness.
- Oversee the coordination and completion of projects with cross-functional teams and senior leaders across medical, nursing, and/or clinical functional areas to achieve targeted strategic performance goals.
- Utilize process improvement methodologies to identify workflow gaps and establish future-state recommendations for medical, nursing and/or clinical workflow mapping.
- Lead and attract top talent, motivate, assess, and manage performance to achieve the highest and best use of talent.
Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.
Required
- Bachelor’s degree, Nursing degree, or other comparable healthcare experience. Master’s Degree preferred.
Five (5) years of experience in Stars or HEDIS including leadership experience developing and implementing new programs for HEDIS, Medicare Advantage, or Medicaid products.
Five (5) years of leadership experience in healthcare management required.
Ten (10) years of experience in hands-on operations role.
Project management experience and skills, including ability to catalyze and energize teams with clear plans, accountabilities, and teamwork to efficiently execute.
Experience in structuring and executing complex analyses to support strategy in a fast-paced, evolving environment.
Knowledge, Skills, and Abilities:
- Intermediate to expert level of knowledge of local, state, and federal laws and regulations pertaining to guidelines from HEDIS.
- Ability to document and analyze complex business requirements and processes.
- Ability to lead a call team and data mining team
- Ability to interface with Senior Level Executives during client meetings I presentations.
- Must be a proactive, hands-on leader with a proven strategic vision who will drive operational performance with a high degree of accountability and integrity.
- Strong financial & data acumen – detail orientated, precision & proven track record managing budgets.
- Ability to give and receive feedback and constructive criticism.
- Ability to be both a strategic and tactical change agent in the healthcare space.
- Self-starter who will take initiative and be proactive when there are multiple priorities.
- Strategic solution-seeker who sees opportunities when others see barriers.
- Strong interpersonal skills and ability to communicate effectively.
- Ability to create compelling and dynamic presentations.
- Ability to handle ambiguity and desire to work in a fast-paced start-up environment.
Physical Requirements
- This job operates in a professional setting. While performing the duties of this job, the employee is regularly required to sit or stand for extended periods of time. Normal manual dexterity is required.
- Normal speaking and hearing abilities to interact with others in an office environment, over telephone or other video conferencing platform.
- The employee is occasionally required to stand; walk; and reach with hands and arms and continuously repeat the same hand, arm finger motion many times as in typing.
Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.
Our priority is the health and safety of our members, colleagues, partners, and community. Proof of COVID-19 Vaccination is required for employment. If you are unable to be vaccinated for medical reasons or sincerely-held religious beliefs, we will consider requests for reasonable accommodations consistent with our policy, and where we are able to provide such accommodations without undue hardship to the company pursuant to applicable law.
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Somatus, Inc. provides equal employment opportunity to all individuals regardless of their race, color, creed, religion, gender, age, sexual orientation, national origin, disability, veteran status, or any other characteristic protected by state, federal, or local law. Further, the company takes affirmative action to ensure that applicants are employed, and employees are treated during employment without regard to any of these characteristics. Discrimination of any type will not be tolerated.
Job tags
Salary
