Community Health Plan of Washington

Director

• Lead strategy and execution for Health Plan ratings strategies (e.g., NCQA, VBP, P4P, EQRO) and D-SNP Stars ratings
• Lead data collection and validation for official HEDIS, CAHPS and HOS reporting to regulatory bodies
• Monitor and analyze performance across HEDIS, CAHPS, and other key health plan rating measures; collaborate with Quality/Population Health leaders to develop and execute targeted improvement plans
• Collaborate with internal teams to ensure accurate and timely data submission to CMS and state agencies
• Facilitate and/or oversee the organization’s cross-functional Star Improvement Committee, as well as cross-departmental collaborative meetings focused on Health Plan rating measure strategies
• Manage vendor contracts and provide vendor oversight, including monitoring key performance indicators and ensuring adherence to contract terms to support Star and/or quality programs
• Develop and implement provider engagement strategies to improve quality outcomes for Medicaid, Exchange and D-SNP members
• Partner with network management, clinical operations, and analytics to identify performance gaps and drive improvement
• Lead clinic partnerships and data integration team to effectively deploy practice transformation and quality coaching models with the CHC network
• Oversee strategies to leverage provider-facing tools, dashboards, and education to support quality and compliance goals
• Lead a cohesive and motivated team of professionals and analysts focused on employing continuous quality improvement techniques leveraging data effectively to support rapid cycle improvements in performance
• Serve as a strategic advisor to executive leadership on quality trends, risks, and opportunities
• Foster a culture of accountability, innovation, and continuous improvement
• Collaborate with leaders in Clinical Services and across the organization to identify and facilitate improvement projects to enhance organizational performance on quality measures
• Lead and collaborate with internal and external stakeholders to ensure Stars, CAHPS/HOS and other quality measurement initiatives are fully integrated throughout the organization, maximizing opportunity to improve outcomes for members
• Set and manage department budget, as applicable.

Senior Director, Quality Ratings – Network Performance