Director of Star Ratings Quality Improvement (Ochsner Health Plan)

This job is responsible for developing, managing and integrating a comprehensive approach through cross-functional organizational teams to improve Ochsner Health Plan's star ratings, including upcoming changes to HEDIS, HOS, CAHPS, and health equity and how they influence overall star performance. Works in collaboration with Hedis team and responsible for customized action plans focusing on enhancing performance in key areas impacting star ratings such as disenrollments, appeals, provider network and member experience. Required to develop frameworks, analytic platforms, tools and/or models for consistently analyzing, interpreting, and extracting data relevant to star ratings. Integrates diverse data sources to gain a comprehensive view of the population by combining health data with SDOH, demographic and behavioral data. Development of concrete blueprints outlining steps for implementing change, based on problem-solving sessions and strategic planning across the organization, including medical management teams. This should include process improvement initiatives, technology adoption plans, or patient engagement strategies. Development of comprehensive reports or studies comparing the organization’s performance against industry standards or competitors. Applies methodologies like the PDSA cycle for implementing strategic initiatives and continually refining these processes based on results and feedback. The Director will independently make decisions that could seriously affect the overall and strategic results.

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential duties.

This job description is a summary of the primary duties and responsibilities of the job and position. It is not intended to be a comprehensive or all-inclusive listing of duties and responsibilities. Contents are subject to change at the company’s discretion.

Education:

Required - Bachelor’s degree in Nursing, Public Health, Business Administration, or related fields.

Preferred - Master’s degree in Nursing, Public Health, Business Administration, or related fields.

Work Experience:

Required - 10 years of experience in healthcare leadership; Experience with healthcare quality, relational databases, and systems analysis; Experience with robust process improvement; Experience with documentation effectiveness tools (Crimson, Truven, 3M, Tableau, Vizient CDB) and analysis of ICD-10-CM data relating to externally reported quality methodologies including AHRQ PSI and CMS HAC.

Certifications:

Preferred - Active Certified Professional in Healthcare Quality (CPHQ) certification.

Knowledge Skills and Abilities (KSAs):

• Effective verbal and written communication skills and the ability to present information clearly and professionally.
• Strong interpersonal and conflict resolution skills.
• Proficiency in using computers, software, and web-based applications.
• Analytical skills and ability to use a logical process to formulate practical solutions.
• Strong decision-making, delegation, and leadership skills and the ability to demonstrate good judgement.
• Excellent time management skills and self-direction.
• Maintains and enhances professional competency.

Job Duties:

• Develops, manages, and integrates a comprehensive, system quality and performance improvement program that supports system quality strategic initiatives.
• Manages and continuously evaluates improvement of key performance indicators.
• Monitors progress on strategic plans and recommends updates to senior executive quality leaders.
• Serves as a system quality and performance improvement partner to service line leaders and division quality leaders.
• Manages documentation effectiveness program that engages HIM, IS, quality, and physician leaders in improvement strategies associated with clinical documentation.
• Develops personnel and workforce.
• Participates in long strategic planning that supports the company mission.
• Performs other related duties as assigned.

The above statements describe the general nature and level of work only. They are not an exhaustive list of all required responsibilities, duties, and skills. Other duties may be added, or this description amended at any time.

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Job Type: Full-time

Benefits:

• 401(k)
• 401(k) matching
• 403(b)
• Dental insurance
• Employee assistance program
• Employee discount
• Flexible spending account
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Parental leave
• Tuition reimbursement
• Vision insurance
• Wellness program

Education:

• Bachelor's (Required)

Experience:

• healthcare quality improvement: 10 years (Required)

License/Certification:

• CPHQ certification (Preferred)

Ability to Commute:

• New Orleans, LA 70112 (Required)

Ability to Relocate:

• New Orleans, LA 70112: Relocate before starting work (Required)

Work Location: In person