Director, Quality Analytics (Director Ii)

Posted Date

3/29/2023

Department(s): Quality Analytics

Reports to: Executive Director, Quality and Population Health

FLSA status: Exempt

Salary Grade: R - $144,000 - $224,400

About CalOptima Health

CalOptima Health is the single largest health plan in Orange County, serving 880,000 members, or one in four residents. Our motto — "Better. Together.” — is at the heart of our mission to serve members with excellence, dignity and respect. We are a public agency made up of compassionate leaders and professionals working together to strengthen our community’s health. If you’re looking for an opportunity to work for an organization dedicated to improving local health care and serving the needs of the most vulnerable, we encourage you to join CalOptima Health.

About The Position

The Director II (Quality Analytics) will be responsible for providing leadership to ensure reporting, tracking and trending of quality performance metrics required by regulators or CalOptima Health leadership. The incumbent will oversee the timely delivery of regulatory required Healthcare Effectiveness Data and Information Set (HEDIS) metrics to National Committee for Quality Assurance (NCQA), California Department of Health Care Services (DHCS) and Center for Medicare and Medicaid (CMS) and will provide vision to enhance data collection to improve the organization’s quality performance to meet strategic goals. The incumbent will be responsible for the strategic vision of the department to meet future expanded requirements of performance measurement evolution from DHCS, Department of Managed Health Care (DMHC) and NCQA. The Director II, (Quality Analytics) is a key thought leader providing frequent feedback to stakeholder organizations including NCQA, DHCS and Association of Community Affiliated Plans (ACAP) regarding proposed, new or changed quality measurement requirements. Additionally, the incumbent will provide leadership for the development, implementation and evolution of provider pay for value programs including alternative payment model programs or incentive programs mandated by DHCS and/or DMHC. The incumbent will oversee the development and implementation of all company surveys to measure member and provider satisfaction and will oversee the data analytics team that supports population health management, network adequacy reporting and ad hoc quality measurement performance requests. The incumbent will coordinate communication keeping senior management and stakeholders informed of health plan and health network quality metrics performance results. The incumbent will work collaboratively with management throughout the organization to promote enhancements to organizational performance and supports the Quality Improvement Committee and sub-committees, as well as other key discussions on strategic and policy-related issues.

Duties & Responsibilities

• Oversees the timely delivery of regulatory required HEDIS and Consumer Assessment of Healthcare Providers and Systems (CAHPS) metrics to NCQA, DHCS and CMS and provides vision to enhance data collection to improve the organization’s quality performance to meet strategic goals.
• Oversees the design, implementation and management of provider incentive programs that are successful and demonstrate positive impact in the health of our members.
• Oversees corrective action plan assignments for underperforming entities on quality metrics.
• Works with Health Network Management and other applicable areas to ensure that quality performance is consistently and effectively communicated to health networks, individual providers, CalOptima Health members and other constituents.
• Develops annual staffing and budget plan and monitors resource allocation for the department.
• Supports regulatory audits as requested.
• Completes other projects and duties as assigned.
• Manages and grows department staff through selection, orientation, training, performance goal setting, performance review and staff development.
• Provides regular and frequent feedback to the Executive Team, Quality Improvement Committee and Board of Directors’ Quality Assurance Committee regarding the status of CalOptima Health’s organizational quality outcomes.
• Participates in strategic planning regarding organizational and quality improvement, including the development of CalOptima Health’s short-term and long-term high level strategic and tactical plans to improve HEDIS, Stars, CAHPS, HOS and other performance metrics.
• Leads regularly scheduled Quality Forum meetings with Health Network quality champions to communicate health network performance and proposed quality programs or initiatives.
• Provides leadership and analytical support resources to NCQA accreditation initiatives including support of the annual Quality Improvement workplan and annual evaluation.
• Cultivates and promotes a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.
• Oversees the development and maintenance of those elements of CalOptima Health’s quality improvement plan that support organizational and quality improvement goals and objectives.
• Directs and assists the team in carrying out department responsibilities and collaborates with the leadership team and staff to support short- and long-term goals/priorities for the department.
• Ensures department policies and procedures are annually reviewed and updated.
• Participates in workgroups and regulator lead technical calls that address both clinical and non-clinical internal activities for which CalOptima Health must demonstrate improvement to meet its contractual requirements with the CMS, DHCS, DMHC and any other applicable regulatory and/or accrediting entities.
• Works with department directors to ensure sufficient funds are allocated within the medical cost budget for implementing appropriate quality initiatives and incentives and within the administrative budget to ensure cost-effective resources are available to achieve key objectives.

Experience & Education

• An equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above is also qualifying.
• Master’s degree in Public Health, Healthcare Administration, Healthcare Informatics or related field required.
• 5 years of progressive leadership experience, including direct supervision of staff required.
• 7 years of quality performance measurement experience (HEDIS, STARS, MCAS, etc.), including quality improvement activities related to data required.

Preferred Qualifications

• Experience utilizing a NCQA certified HEDIS reporting tool to generate HEDIS results end-to-end.
• Experience making presentations to senior level management, stakeholders and Board members.
• HMO, Medi-Cal/Medicaid, Medicare and managed care quality measurement experience.
• Managed care experience in a highly delegated model.

About Our Benefits & Wellness Options

At CalOptima Health, we know that a healthy and happy workforce is a thriving workforce, which is why we offer a comprehensive benefits package, including participation in the California Public Employees Retirement System (CalPERS), low-cost medical/vision/dental insurance options, and paid time off. To support quality work-life balance, we allow flexible scheduling during core business hours, telework options for some positions, work schedules that allow every other Friday off (9/80 schedule), and a wellness program featuring diverse activities. Additionally, CalOptima Health contributes 4% of pensionable earnings to a 401(a) retirement program with no required employee contribution. Employees also have access to 457(b) retirement plans with pre/post-tax contribution options.

CalOptima Health is an equal employment opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health wants to have qualified employees in every job position. CalOptima Health prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima Health also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics.

If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability.

Tracking Code

4244-117