Managing Director Clinical Operations
Full Time
Washington, DC
Posted
Job description
Job Description Summary
Provides leadership, development and execution of strategic plan for Clinical Quality Operations in support of Member Care and Benefits (MC&B) and FEP. Participates in the development and design of long-term plans for integrating the use of clinical and business information in FEP to support benefit design, clinical programs, HEDIS initiatives, plan and customer intelligence needs as well as supporting the Diversity and Inclusion programs information needs within FEP. Leads the strategy for multiple cross-functional projects, services, and associated deliverables related to clinical data acquisition and integration in support of HEDIS operational activities required by OPM and NCQA. Oversight and coordination for multiple Plan interfaces including QOG, HIT, and IPAG. Responsible for Plan support of benefit cost and all quality metrics outcomes, accreditation of all Plans as well as the FEP Corporate Accreditation program for FEP. Leads initiatives that drive higher HEDIS and CAHPS rates to increase service charge to the program and ultimately the Plans. Significant interaction with Plans, Directors, internal divisions, departments, and Association staff in value- added, cost-effective resources. Multi-tasked, fast- paced, cross-functional environment with critical deadlines and frequent last minute/urgent requests. Completion of responsibilities in a timely and accurate manner is critical.
Provides leadership, development and execution of strategic plan for Clinical Quality Operations in support of Member Care and Benefits (MC&B) and FEP. Participates in the development and design of long-term plans for integrating the use of clinical and business information in FEP to support benefit design, clinical programs, HEDIS initiatives, plan and customer intelligence needs as well as supporting the Diversity and Inclusion programs information needs within FEP. Leads the strategy for multiple cross-functional projects, services, and associated deliverables related to clinical data acquisition and integration in support of HEDIS operational activities required by OPM and NCQA. Oversight and coordination for multiple Plan interfaces including QOG, HIT, and IPAG. Responsible for Plan support of benefit cost and all quality metrics outcomes, accreditation of all Plans as well as the FEP Corporate Accreditation program for FEP. Leads initiatives that drive higher HEDIS and CAHPS rates to increase service charge to the program and ultimately the Plans. Significant interaction with Plans, Directors, internal divisions, departments, and Association staff in value- added, cost-effective resources. Multi-tasked, fast- paced, cross-functional environment with critical deadlines and frequent last minute/urgent requests. Completion of responsibilities in a timely and accurate manner is critical.
Responsibilities include but are not limited to:
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Responsible for developing and executing a long-term plan for leveraging business intelligence data in support of clinical quality operations, benefit cost and HEDIS operational needs. Acts as the primary FEP interface with BHI and for leading and guiding integration of data into day-to-day operations within MC&B. Position will be responsible for disseminating BHI data within MC&B and providing direction and analysis of potential uses of this data in guiding long-term decision making.
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Executes, oversees, and develops the strategy as well as important quality outcomes to support OPM’s Quality, Customer Service and Resource utilization programs mandated by OPM. Responsible for team working with each Plan to implement quality improvement initiatives to drive greater member health and outcomes. Ensures the development of FEP Accreditation workplan and submission of annual NCQA Corporate Survey.
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Responsible for contract management and procurement related activities for existing and new contracts. Ensure procurement activities are aligned with strategic objectives and adhere to FEP procurement processes. Monitors contractor performance, contract deliverables and SLAs. Ensure vendor schedule and quality controls are adhered to.
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Provides guidance for clinical operational aspects of the program and has periodic consultation with practitioners in the field. Represents Clinical Quality Operations on internal and external groups, as assigned. Represents FEP interests on various BHI workgroups. Builds/maintains excellent relationships with internal and external business partners and/or customers.
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Participates in a cross-functional analytic organization to develop sound.
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Assures confidentiality of personal health information in compliance with HIPAA regulations, and Plan specific financial and clinical outcomes.
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Provides direction and leadership to staff that includes a) Recruit, train, and develop staff, b) Provides guidance to staff on quality improvement initiatives/projects.
Responsibilities include but are not limited to:
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Bachelor's Degree with a healthcare concentration (e.g. healthcare statistics)
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A minimum of 10 years of experience within a health Plan business environment with a minimum of seven years within a managed care or health services delivery setting.
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A minimum of 10 to 12 years of experience within a health Plan business environment with a minimum of seven years within a managed care or health services delivery setting, preferably with expertise in setting the strategic direction of program(s)
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Minimum of 5 years’ experience in HEDIS quality improvement
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Ability to work with clinical areas and to develop processes to incorporate health information management into their day-to-day operations and decision-making processes.
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Must have experience overseeing projects that leverage large data repositories and/or relational databases, as well as experience with data mining and its application for business decisions and competencies.
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Ability to build consensus for business results in a decentralized decision-making structure, relying on excellent process management skills.
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Experience with health plan on developing strong scores on HEDIS and CAHPS metrics.
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Excellent communication (written and oral) and people skills with an ability to communicate to small and/or large audiences.
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Applied knowledge of SAS and SQL a plus and be able to leverage those systems in the fulfillment of strategic direction.
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Demonstrated ability to take data and turn it into actionable business decisions and analyses.
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Strong PC skills with experience using database programs, spreadsheets, and word processing, including all components of MS Office (particularly MS Excel and MS Access).
Preferred Education, Certifications and Experience
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Applied experience with business intelligence applications, Cognos.
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A current, unrestricted clinical license in the fields of either medicine, pharmacy, nursing or related work experience in quality programs
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Graduate degree in healthcare administration or other relevant concentration.
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The ability to develop approaches that meet required objectives.
People Management – Yes
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