Senior Director of Quality Performance Improvement - New York, NY

MetroPlus; New York (NY); On-site; USD 130,000 - 180,000; Full time

Job summary

MetroPlusHealth seeks a Senior Director of Quality Performance Improvement to lead the strategic vision for the Quality Management department. This role ensures quality improvement across all lines of business through oversight, provider engagement, and execution of metrics aligning with healthcare standards, requiring extensive experience in the field.

Qualifications

• 10+ years of experience in healthcare or managed care.
• 5+ years in a clinical setting preferred.
• Extensive knowledge of HEDIS/QARR/CAHPS/HOS and CMS Star Ratings.

Responsibilities

• Develop the vision and strategic direction for Quality Management.
• Lead a cross-functional team to develop strategies for healthcare quality.
• Design and implement organization-wide quality improvement strategies.

Skills

Leadership and team building

Strong analytical skills

Effective communication

Customer focus

Technical skills

Education

Master’s degree in public health, health administration, or a clinical field

Tools

Microsoft Office Suite

Job description

Empower. Unite. Care.

MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that healthcare is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day.

About NYC Health + Hospitals

MetroPlusHealth provides high-quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens, and Staten Island through a comprehensive list of products, including Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, and more. As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlusHealth includes over 27,000 providers, specialists, and clinics. For over 30 years, MetroPlusHealth has been dedicated to building strong relationships with its members and providers to support healthier lives.

Position Overview

MetroPlusHealth seeks a Senior Director of Quality Performance Improvement to develop and lead the strategic vision for the Quality Management department. This role involves designing and executing the organization’s quality improvement workplan, serving as a subject matter expert for HEDIS/QARR, CAHPS, HOS metrics, and participating in state and CMS quality programs. The Senior Director will oversee a cross-functional team focused on enhancing quality in preventive, chronic, behavioral health, and member experience across all lines of business. The role also involves leading provider engagement strategies and providing clinical oversight for quality improvement initiatives.

Responsibilities include ensuring timely completion of regulatory projects such as DOH Performance Improvement Projects, Medicare CCIP, and supporting the Model of Care, as well as participating in audits related to clinical and operational quality metrics.

Job Description

• Develop the vision and strategic direction for Quality Management, collaborating with the VP of Quality Management to implement the organization’s quality improvement plan and serve as an expert on HEDIS/QARR/STARS, CAHPS, and HOS metrics.
• Lead a cross-functional team to develop strategies, implement action plans, and oversee operations to meet healthcare quality and cost goals.
• Drive provider engagement strategies to address gaps-in-care and improve risk scores, ensuring quality projects align with clinical standards and data requirements.
• Design and implement organization-wide quality improvement strategies for CAHPS metrics, enhancing member experience through data-driven activities and collaboration.
• Align quality measures with incentive programs like Member Rewards and Pay for Performance to maximize incentives and improve health outcomes.
• Identify areas for improvement, analyze marketplace and member/provider behaviors, develop predictive models, conduct root-cause analysis, and evaluate program effectiveness.
• Identify process improvements, automate workflows, and implement efficiencies.
• Maintain current knowledge of technical specifications for HEDIS/QARR/CAHPS and CMS Star Ratings, including operational measures.
• Oversee regulatory compliance for projects like DOH PIPs, Medicare CCIP, and Model of Care, including audits.
• Lead work groups with vendors and staff to improve quality measures and evaluate intervention effectiveness, reporting progress to senior committees.

Minimum Qualifications

• Master’s degree in public health, health administration, or a clinical field.
• 10+ years of experience in healthcare or managed care, with 5+ years in a clinical setting preferred.
• Strong analytical skills, with a background in statistics or data analysis a plus.
• Extensive knowledge of HEDIS/QARR/CAHPS/HOS and CMS Star Ratings.
• Proficiency in Microsoft Office Suite.
• Clinical license (MD, NP, RN, PharmD, LMSW/LCSW, etc.) with clinical experience preferred.

Professional Competencies:

• Leadership and team building
• Integrity and trust
• Customer focus
• Technical skills
• Effective communication