The Senior Director of Quality, Safety and Provider Solutions is responsible for leading, coordinating and executing the key quality processes associated with Accreditation and Regulatory compliance oversight involving external entities such as: AHCA, CMS, NCQA, and others. This includes working proactively to influence quality standards and measurement trends at a state, national and association level.
The Senior Director will provide leadership in the development and implementation of clinical quality initiatives in accordance with accreditation and regulatory requirements. As well as, oversight of clinical quality activities and patient safety programs relative to cultural/linguistic & social determinants of health.
The Senior Director will lead, coordinate and oversee the Commercial & Medicare Risk Management process in accordance with F.S. 641.55 to include oversight of the overall program components including training, incident reporting and the annual review.
The Senior Director will provide leadership, oversight, collaboration, and integration of the delegated/vendor care partner relationships, and providers that directly impact quality improvement initiatives/activities to ensure an integrated, cohesive collaborative approach to improving HEDIS/CAHPS/QRS/EES/QIS performance.
The Senior Director will lead, coordinate, and oversee the Quality Improvement Governance Structure and Quality Strategy execution.
Job duties include but are not limited to:
Provide leadership for the development, implementation and execution of plans to meet regulatory compliance at state and national level, achieving standards set forth by accrediting entities; effectively communicates compliance status; provide leadership of Accreditation and Regulatory Survey visits by external entities such as: AHCA, CMS, NCQA, and others
Provide leadership in the identification, prioritization, and implementation of quality initiatives to improve clinical quality and satisfaction metrics (HEDIS/CAHPS/QRS/EES/QIS) as well as measuring clinical effectiveness
Business Owner of Delegation compliance process providing leadership and oversight activities of delegated entities including onsite assessment, ongoing monitoring & evaluation, and working closely with legal in contractual development of delegation attachment and matrices with presentation to committee for approval
Provide Leadership initiated work efforts to optimize the categorization of QIE focusing on improving the capture, monitoring/evaluation of cost and quality performance metrics
Provide leadership in the development, implementation, and execution of quality improvement initiatives based on provider quality and profiling data to obtain better outcomes
Identify and execute on strategic initiatives for members and providers that focus on quality, safety and affordability while maintaining responsiveness to market demands
Lead levels of performance and provide leadership in assisting in employees' professional growth by planning and building an effective organization; maintaining employee morale; motivating, recognizing and rewarding others; coaching and developing, promoting self-development
Related Bachelor’s degree or additional related equivalent work experience
Medical Licensure required (Registered Nurse, APRN, PA)
8+ years related work experience
3+ years direct supervisory/management experience
Health Insurance industry experience, including Healthcare Risk Management and/or NCQA accreditation compliance
Strong understanding of scientific methodologies and CQI concepts, study designs, & outcomes measurements
5 or more years of proven ability to review, interpret and implement NCQA accreditation and regulatory requirements
Strong written and verbal communication skills
Ability to navigate complex environments and achieve results through influence
Experience in working with Officer-level executives
Leadership ability to work with cross-functional business teams
Must possess & promote effective skills in the following areas: interpersonal skills, communication (written & oral), problem solving, leadership, & motivational skills
Must have proven leadership experience
Actively seeks opportunities to communicate and educate others at multiple levels of the organization regarding current state and emerging trends
We are an Equal Opportunity Employer/Protected Veteran/Disabled.
Internal Number: 18878
About Florida Blue
Florida Blue, Florida’s Blue Cross and Blue Shield company, is a leader in Florida’s health industry. Helping
people in their pursuit of health reflects Florida Blue’s commitment to ensuring affordable plans, providing
personal support and building strong communities that enable health and wellness for all.