Vice President, Clinical Quality

Daman - National Health Insurance Company; Abu Dhabi; On-site; AED 250,000 - 350,000; Full time

Job summary

A leading health insurance company in the UAE seeks an experienced Clinical Quality Manager to develop and execute strategies ensuring high-quality care delivery. The role involves overseeing clinical quality metrics, regulatory compliance, and managing provider performance while promoting value-based care initiatives. Candidates should have extensive clinical experience and strong leadership skills.

Qualifications

• Minimum 10 years of clinical experience in the healthcare industry.
• Minimum 3 years in health insurance industry.
• Minimum 5 years in a management/supervisory position.

Responsibilities

• Develop and execute clinical quality strategy aligned with organizational goals.
• Oversee preparation and submission of quality data to regulatory bodies.
• Lead auditing process for healthcare providers to ensure compliance.

Skills

Leadership

Data Analysis

Strategic Thinking

Problem Solving

Communication

Education

Bachelor's degree in medicine

Bachelor's degree in nursing

Bachelor's degree in healthcare administration

Master's degree

Job description

Role Purpose

• Develop and execute the organization's clinical quality strategy, ensuring alignment with organizational goals, regulatory requirements, and value-based care initiatives.
• Develop, monitor, and analyze clinical quality performance indicators (KPIs) to assess the effectiveness of care delivery, provider performance, and member health outcomes.
• Ensure compliance with all applicable healthcare organizations including CMS (Centers for Medicare & Medicaid Services), and accreditation standards (e.g., NCQA, URAC).
• Oversee the preparation and submission of quality and performance data to regulatory bodies and healthcare providers.
• Drive initiatives that align clinical quality with cost-effective care delivery, optimizing the balance between high-quality outcomes and managing healthcare costs.
• Develop value-based care models that incentivize high-quality, efficient care delivery while managing total cost of care.
• Provide regular reports on clinical quality metrics to the senior leadership team and key stakeholders, identifying areas for improvement and outlining actionable recommendations.
• Establish and maintain strong partnerships with healthcare regulatory authorities, physician networks, hospitals, and other clinical entities to ensure high-quality care coordination and value-based outcomes.
• Oversee the design, implementation, and ongoing management of pay-for-quality (PFQ) programs that incentivize providers to deliver high-quality, cost-effective care to members.
• Ensure that pay-for-performance metrics align with organizational goals and regulatory requirements, focusing on improving clinical outcomes and reducing unnecessary costs.
• Collaborate with provider networks to communicate program requirements, set clear performance expectations, and drive improvements in care quality and efficiency.
• Analyze performance data to determine incentives, penalties, and adjustments based on quality scores.
• Lead the auditing process for healthcare providers within the network to ensure compliance with clinical quality standards, coding accuracy, billing practices, and utilization management guidelines
• Oversee the regular auditing of provider claims, clinical documentation, and quality data reporting to ensure adherence to internal policies, payer requirements, and industry regulations.
• Responsible for a result-oriented management and development of people and resources, including provision of a strong leadership presence involving resource allocation, monitoring, reporting, and conducting regular staff meetings
• Promote the recruitment and development of UAE Nationals to contribute to Daman's strategic goals

Key Requirements and Qualifications

• Minimum 10 years of clinical experience in the healthcare industry
• Minimum 3 years of health insurance industry related background
• Minimum 5 years of which in a management/supervisory position
• Bachelor's degree in medicine, nursing, healthcare administration (Master's degree preferred).

Skills and Competencies

• Dynamic, self-driven with strong business understanding and background of managed care models and value-based reimbursement
• Strong understanding of health insurance operations, data analysis and performance improvement
• Strategic thinking with strong focus on results and high quality of work
• Very good leadership skills including people management, selection and development skills
• Very good command of written/spoken English
• Very good analytical, planning, forecasting, execution and problem-solving skills
• Very good communication, negotiation, and presentation skills
• Knowledge of regulatory requirements and healthcare compliance.