Director, Government Quality Programs

Job ID: J131755
Company: Highmark Inc
Location: Pittsburgh, PA, United States
Full/Part Time: Full time
Job Type: Regular
Posted at: Sep 12, 2018

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Description

JOB SUMMARY

This job directs and manages the enterprise wide Medicare/Medicaid (Stars and/or ACA Quality Performance) programs, which provides oversight and guidance for the enterprise portfolio of programs and projects. Works collaboratively with multiple stakeholders, vendors and various cross-functional teams, locations and departments to improve Stars and/or Quality Rating outcomes for Medicare Advantage, Federal Employee Program and Exchange products in three states. Leads enterprise efforts to maximize Mobile Clinic partnership with AHN and other physician partners. Leads efforts to perform analysis of enterprise-wide practices to identify opportunities for improvement. Designs, implements and executes strategies and works with cross-functional clinical, pharmaceutical, operational, IT and Performance Management improvement teams to ensure overall goals of the Organization are met and to optimize outcomes. Provides budgetary oversight for the successful execution of strategies direct and indirect reports that ensures delivery of $200+M in annual revenue. Collaborates with the company's Medicare, FEP, and/or ACA's Quality Program Management processes, procedures and best practices and chairs the oversight governance committee to ensure all supporting areas are utilizing standard processes, tools and data standards for managing the interventions. The incumbent provides regular status, program health and escalating cross-portfolio dependencies, project risks and items for management attention to the executive leadership team. 

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, FEP (PIP) and ACA's enterprise Quality performance manaement practice. Execute and deliver all FEP and ACA Quality performance management driven initiatives.
  • Manage portfolio key initiatives, through a disciplined, customer focused, program management approach; identify and resolve project and program issues and risks.
  • Access current processes and implement FEP and ACA performance management improvement programs. 
  • Execute and deliver the Mobile Clinic performance management practice driven initiatives 
  • Ensure accuracy and compliance with CMS state and federal guidelines.
  • Other duties as assigned.

QUALIFICATIONS

Minimum

  • Bachelor's Degree in Business Administration/Management or Related Discipline
  • 10 - 15 years in Project Management. To Include: 5 - 7 years in Program Management; 5 - 7 years in the health Insurance Industry; 5 - 7 years in Leadership

Preferred

  • Master's Degree in Business Administration/Management

SKILLS

  • Leadership
  • Consulting
  • Communication Skills
  • Portfolio Management

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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