Director, Quality & Process Improvement, HEDIS Audit

Stellenbeschreibung:

Lead and direct process improvement initiatives by utilizing process improvement methodologies in the analysis of current operations and design of improvement projects across all areas that impact operations
Support NCQA HEDIS audit readiness and compliance, ensuring accurate and timely submissions
Lead daily audit readiness activities, including Roadmaps, Section 5 documentation, Measure Specifications, CAHPS coordination, and auditor engagement
Oversee the administration, coordination and evaluation of quality assurance and training
Direct the execution of performance improvement projects, including process mapping and process design including HEDIS audit timelines and deliverables
Serve as primary point of contact for auditors and leadership, supporting audit communications and successful outcomes
Create and maintain dashboards, communications, and strategies to improve effectiveness
Research and develop best practices, policies, procedures, and goals in compliance with internal and external guidelines
Oversee data analysis and gathering processes and programs to establish costs and benefits of process effectiveness and efficiency
Ensure business unit is compliant with URAC and Joint Commission Accreditation standards
Review and implement new technological tools and processes
Establish strong collaborative relationships with all functional units and their leaders

Bachelors Degree in related field
6+ years of quality and process improvement experience
Healthcare industry experience preferred
Knowledge of research methodologies including measures and outcomes
knowledge of process mapping, process design, and workflow management software and applications
URAC and Joint Commission Accreditation experience preferred
Experience with NCQA HEDIS measures or audit processes highly preferred