Job Description:

Summary:
This position is responsible for plan-wide oversight and strategic direction of quality programs and regulatory activities across all lines of business, member/customer experience improvement activities, compliance with regulatory agency requirements, including NYS DOH, CMS and NCQA programs. The Director is accountable for the oversight and coordination of all activities, including by not limited to the development, operations and implementation of improvement programs and process, and implementation and evaluation of quality improvement interventions impacting members, providers, employers and the community at large. The position serves as a subject matter expert for all LOBs and partners across the organization to design and implement strategies to achieve corporate goals.

Essential Accountabilities:

Collaborates with Health Plan-wide leadership on quality improvement multi-year strategy development, implementation, and evaluation. As necessary, modifies process to meet the unique needs of the lines of business. Assures efforts are aligned and prioritized to achieve business goals related to improved clinical quality, members experience and operational performance.

Provides oversight for multi-year and annual plans and corresponding measurement and tracking to fulfill regulation requirements set forth by NYS Department of Health, CMS, IPRO and NCQA requirements for quality improvement programs.

Oversees the development and execution of the organization-wide operational and member experience improvement strategy, inclusive of ensuring implementation of customer experience initiatives across the enterprise to improve quality performance across all lines of business.

Manages multiple high risk, high-visibility, cross-functional projects/initiatives through the development and oversight of an improvement workplan, including but not limited to required improvement plans deemed necessary from CMS, NYS Department of Health, and/or NCQA and leads the development and monitoring of viable, creative solutions to drive broad-scale improvement and address multiple customer needs resulting in significant revenue impacts to the Health Plan.

Applies analytical techniques and provides in-depth analysis, reporting and recommendations using critical thinking and sound judgment.

Drives enterprise awareness and engagement with health plan quality program through cross-divisional partnerships and corporate communications.

Drive team understanding of best practice programs and insights through engagement with BCBSA, other plan benchmarking and other resources.

Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies' mission and values, adhering to the Corporate Code of Conduct, and leading to the Lifetime Way values and beliefs.

Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures.

Maintains knowledge of all relevant legislative and regulatory mandates and ensures that all activities are compliant with these requirements.

Conducts periodic staff meetings to include timely distribution and education related to departmental and Ethics/Compliance information.

Regular and reliable attendance is expected and required.

Performs other duties and functions as assigned by management.

Minimum Qualifications:

Minimum of eight years progressive health care or management experience with at least five years in a leadership role driving program development, Health Plan wide initiatives and/or progressive quality improvement.

Bachelor's Degree in Business Administration, Health Care Administration or related field required. Master's Degree preferred.

Subject matter expertise in quality measurement and leading performance improvement processes through the use of industry accepted modalities, process improvement tools and techniques (Lean, Six Sigma, PDSA, etc.) required.

Strong expertise and background dealing with regulatory and accreditation agencies such as NCQA, CMS, Federal and State Agencies.

Strong process and program management skills, analytical, creativity and initiative in problem solving and solution identification.

Resourcefulness as demonstrated by the effective application of professional knowledge to new situations. Possess planning, organizing, conflict resolution, negotiation, and interpersonal skills.

Physical Requirements:

Ability to work prolonged periods sitting and/or standing at a workstation and working on a computer.

Ability to work while sitting and/or standing at a workstation viewing a computer and using a keyboard, mouse and/or phone for three (3) or more hours at a time.

Ability to travel across the Health Plan service region for meetings and/or trainings as needed.

**

One Mission. One Vision. One I.D.E.A. One you.

Together we can create a better I.D.E.A. for our communities.

At the Lifetime Healthcare Companies, we're on a mission to make our communities healthier, and we can't do it without you. We know diversity helps fuel our mission and that's why we approach our work from an I.D.E.A. mindset (Inclusion, Diversity, Equity, and Access). By activating our employees' experiences, skills, and perspectives, we take action toward greater health equity.

We aspire to reflect the communities we live in and serve, and strongly encourage people of color, LGBTQ people, people with disabilities, veterans, and other underrepresented groups to apply.

OUR COMPANY CULTURE:

Employees are united by our Lifetime Way Values & Behaviors that include compassion, pride, excellence, innovation, and having fun! We aim to be an employer of choice by valuing workforce diversity, innovative thinking, employee development, and by offering competitive compensation and benefits.

In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position.

Equal Opportunity Employer

Compensation Range(s):

Grade 212: Minimum $108, 098- Maximum $199, 992

The salary range indicated in this posting represents the minimum and maximum of the salary range for this position. Actual salary will vary depending on factors including, but not limited to, budget available, prior experience, knowledge, skill and education as they relate to the position's minimum qualifications, in addition to internal equity. The posted salary range reflects just one component of our total rewards package. Other components of the total rewards package may include participation in group health and/or dental insurance, retirement plan, wellness program, paid time away from work, and paid holidays.

Please note: There may be opportunity for remote work within all jobs posted by the Excellus Talent Acquisition team. This decision is made on a case-by-case basis.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

Equal Opportunity Employer - minorities/females/veterans/individuals with disabilities/sexual orientation/gender identity

Minimum Salary: 0.00 Maximum Salary: 0.00 Salary Unit: Yearly