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Memorial Hermann Health System

Memorial Hermann is where you belong.

Director, Quality Assurance, Health Plan

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Location 929 Gessner Road,Houston,TX 77024 Facility Memorial Hermann Tower Category Health Solutions (Inactive) Type Full time Requisition 100088940

At Memorial Hermann, we’re about creating exceptional experiences for both our patients and our employees. Our goal is to provide opportunities for our diverse employee population that develop and grow careers in a team-oriented environment focused on patient care.

Every employee, at every level, begins their journey at Memorial Hermann learning about the history of the organization and its established culture built on trust and integrity. Our employees drive this culture, and we want you to be a part of it.

Job Summary

The Director of Quality Management (QM) is responsible for strategically developing and coordinating Quality Management Program-related activities, objectives, and analysis for the growing Memorial Hermann Health Plan. The Director of QM provides ongoing maintenance and evaluation of systems and strategies to support the improvement of quality management accreditation through promoting and supporting innovation. This role acts as organizational champion for NCQA accreditation, HEDIS reporting, Performance Improvement Plans, Quality Improvement Activities and the Quality Improvement Committee. This position also works closely with the other system executives in seeking alignment across functional areas, including utilization management, quality management, network management and clinical coverage, and department policies and procedures. The position reports to the Chief Operating Officer.

Job Description

Minimum Qualifications

Education: Bachelor Degree required in nursing, pharmacy or related clinical area required; Masters preferred

Licenses/Certification: Current, unrestricted state license without encumbrances; CPHQ certification preferred

Experience / Knowledge / Skills:

  • Eight (8) years in healthcare (hospital or patient care setting) with progressive responsibility in a healthcare environment, of which at least five (5) are in a significant management capacity in managed care contracting
  • Knowledgeable and compliant with all relevant laws, rules regulations and accreditation standards and requirement
  • Prior leadership in achieving NCQA or similar accreditation (e.g. URAC, AAAHC)
  • Mastery knowledge in Quality Management specifically in a managed care environment w/focus on Medicaid/Medicare
  • Demonstrate effective working relationships with Executives, Physicians, Directors, and staff
  • Ability to serve as liaison to external regulatory and sanctioned reporting agencies to maintain, correct, and facilitate nationwide public reporting of patient safety standards and data
  • Excellent written, verbal, and presentation skills and ability to present information internally and externally related to patient safety trends, corrective actions, and changes to national and local trends
  • Knowledge of evidence based practice guidelines for clinical care and quality, and patient safety.
  • Ability to work collaboratively with healthcare professionals at all levels to achieve established goals nd improve quality outcomes
  • Experience in continual process improvement (e.g. Six Sigma)
  • Demonstrates commitment to the Partners-in-Caring process by integrating our culture in all internal and external customer interactions; delivers on our brand promise of “we advance health” through innovation, accountability, empowerment, collaboration, compassion and results while ensuring one Memorial Hermann.

Principal  Accountabilities

  • Accountable for health care quality projects and initiatives through direction setting and leadership.
  • Oversees the quality management activities and links to business goals.
  • Proactively builds strong teams and business relationships, both internally and externally.
  • Serves as a resource and subject matter expert (SME) on aspects of the quality program to develop and influence business strategies.
  • Makes business decisions based on the results of research and data analysis.
  • Directs the QM functional department including development and oversight of performance metrics and application of HR policies and procedures.
  • Evaluates and prioritizes recommendations for quality improvement to senior management and/or customers.
  • Partners with sales and marketing in their efforts to acquire and retain customers.
  • Communicate, collaborate and cooperate with internal and external stakeholders.
  • Adheres to all Compliance/Program Integrity requirements.
  • Complies  with HIPAA Regulations
  • Ensures safe care to patients, staff and visitors; adheres to all Memorial Hermann policies, procedures, and standards within budgetary specifications including time management, supply management, productivity and quality of service.
  • Promotes individual professional growth and development by meeting requirements for mandatory/continuing education and skills competency; supports department-based goals which contribute to the success of the organization; serves as preceptor, mentor and resource to less experienced staff.
  • Other duties as assigned.

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