Director, Clinical and Service Quality (PA)

Job ID: J129116
Company: Gateway Health Plan
Location: Pittsburgh, PA, United States
Full/Part Time: Full time
Job Type: Regular
Posted at: Sep 6, 2018

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Description

JOB SUMMARY

The job directs and manages the Gateway Medicare/Medicaid quality performance programs, which provides oversight and guidance for the enterprise portfolio of programs and projects.  Works collaboratively with multiple stakeholders and various cross-functional teams, locations and departments to improve Stars and/or quality rating outcomes for both Medicare/Medicaid products. Lead efforts to perform analysis of enterprise-wide practices to identify opportunities for improvement   Designs, implements and executes strategies and work with cross-functional clinical, pharmaceutical, operational, IT and other improvement teams to ensure overall goals of the organization are met and to optimize outcomes. Collaborates with the company’s Medicare/Medicaid leadership committees to ensure that new programs and projects are aligned to divisional and corporate strategic objectives and direction. The incumbent develops and maintains the Medicare Stars and/or Medicaid program management processes, procedures and best practices and will chair the oversight governance committee to ensure all supporting areas are utilizing standard processes, tools and data standards for managing the interventions. The incumbent escalates cross-portfolio dependencies, project risks, and items for management attention to the executive leadership group.

ESSENTIAL RESPONSIBILITIES

  • Perform management responsibilities including, but not limited to: involved in hiring and termination decisions, coaching and development, rewards and recognition, performance management and staff productivity.  Plan, organize, staff, direct and control the day-to-day operations of the department; develop and implement policies and programs as necessary; may have budgetary responsibility and authority.
  • Partner with all levels of management to assemble project teams and work groups to produce deliverables required to achieve the objectives of a defined project/program.
  • Manage the Stars and/or Medicaid enterprise performance management practice, responsible for the execution and delivery of all Medicaid performance management driven initiatives.
  • Manage a portfolio of key initiatives, through a disciplined, customer focused, program management approach; identify and resolve project and program issues and risks.
  • Assess current processes and implement Medicaid performance management improvement programs.
  • Direct and is accountable for professionals who lead multidisciplinary work groups throughout the enterprise to develop interventions and processes to advance quality performance.
  • Other duties as assigned.

EDUCATION

Required

  • Bachelor's Degree in Business Administration/Management


Substitutions

  • None

Preferred

  • Master's Degree in Business Administration/Management or Public Health

EXPERIENCE

Required

  • 5 - 7 years of experience in Quality Improvement
  • 5 - 7 years of experience in Leadership
  • 5 - 7 years of experience in Compliance
  • 3 - 5 years of experience in Data Analytics

Preferred

  • None

LICENSES AND CERTIFICATION

Required

  • None

Preferred

  • None

SKILLS

  • Data Analysis
  • Written Communications
  • Presentation Delivery
  • Performance Improvement
  • Problem Solving & Decision Making
  • Conflict Management
  • Business Analysis
  • Operations Management
  • Vendor Management
  • Forecasting

Language (Other than English) 

None

Travel Required

0%  - 25%

PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS

Position Type

Office-Based

Teaches / trains others regularly

Frequently

Travel regularly from the office to various work sites or from site-to-site

Frequently

Works primarily out-of-the office selling products/services (sales employees)

Never

Physical work site required 

Yes

Lifting: up to 10 pounds 

Occasionally

Lifting: 10 to 25 pounds

Occasionally

Lifting: 25 to 50 pounds 

Rarely

Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement: This position adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.
EEO is The Law
Equal Opportunity Employer Minorities/Women/ProtectedVeterans/Disabled/Sexual Orientation/Gender Identity (http://www1.eeoc.gov/employers/upload/eeoc_self_print_poster.pdf)
We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact number below.
For accommodation requests, please call HR Services at 844-242-HR4U or visit HR Services Online at HRServices@highmarkhealth.org

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