Vice President, Clinical Quality Job

Looking for a chance to do meaningful work that touches millions? Come join the hardest working, nonprofit health plan in California and help us shape the future of health care. Blue Shield of California is focused on transforming health care by making it more accessible, affordable and customer-centric. Being a mission-driven organization means we do much more than serve our 3.5 million members: we were the first health plan in the nation to limit our annual net income to 2 percent of revenue and return the difference to our customers and the community, and since 2005 we have contributed more than million to the Blue Shield of California Foundation to improve community health and end domestic violence. We also believe that a healthier California begins with our employees, so we provide them with resources to develop and maintain a healthy lifestyle through our award-winning wellness program, Wellvolution.

We're hiring smart thinkers and doers who want to work for a leader and innovator in the challenging, ever-changing healthcare space. Come and help us make health care better for everyone.

Description:

Opportunity

The Vice President, Clinical Quality is dedicated to leading the teams that provide Quality Management in support of the Blue Shield mission to create and deliver a high quality, low cost healthcare system in California. This role is responsible for developing and executing all aspects of the clinical quality strategy and operations for Blue Shield and providing clinical oversight of the performance of provider organizations with which we contract. The VP, Clinical Quality reports to the Chief Health Officer.

The purpose of the VP, Clinical Quality position is to provide leadership and oversight of developing and implementing our Clinical Quality strategy to achieve our Healthcare Quality goals, in both our ACO and non-ACO delivery networks.

The Clinical Quality function includes owning the enhancement and operationalization of the Healthcare Quality Index, and the strategies and tactics required to achieve our Blue Shield of California Healthcare Quality Index goals, as well as delivering on our commitments to comply with all regulatory requirements (e.g., NCQA, DMHC, CMS) and obligations.

The position can be located in any of our California offices.

Specific Responsibilities Include:

Lead the Quality Team

The VP, Clinical Quality has the following responsibilities:

• This position currently has the following direct reports:

• Senior Director, Quality Management

• Senior Director Medicare Star Strategy

• Director Quality Analytics

• Senior Project Manager

• Senior Business Manager

• Communications Manager

• Executive Assistant

Serve as Medical Director for Quality

• Develop, document and implement the BSC Quality Program

- Setting the quality strategy

- Articulating the program to implement the strategy

- Performing an annual program evaluation to determine the effectiveness of the program and opportunities for improvement

- Lead the organization's HEDIS, CAHPS, and Medicare Stars' Clinical Performance improvement to include:

• Strategy for improving areas of low performance

• Interventions to implement the strategy

• HEDIS pursuit and data collection

• Oversight and leadership to credentialing and re-credentialing

• Oversee the quality of vended programs including disease management, wellness, and behavioral health

• Oversee the development, implementation and operations of data and analytics for HCQA

• Review and approve quality related clinical guidelines

• Lead the Potential Quality Issues (PQI) program

• Lead the efforts to host and respond to Regulatory oversight

• Lead the accreditation efforts for National Committee for Quality Assurance (NCQA) and Utilization Review Accreditation Commission (URAC). Provide support to the organization in order to meet the standards.

• Staff the Board Quality Improvement Committee

• Represent BSC in external quality collaborations e.g. PBGH

Qualifications:

Candidate Profile and Requirements:

Education/Credentials:

• Medical degree

• Active, unencumbered license (MD or DO); California license preferred

Required Experience:

• 7-10 years managed care experience, including management/people leadership experience and experience in Quality Management

Preferred:

• Strong familiarity with California managed care marketplace

• Prior experience with Blues Plans.

• Five years clinical experience

Knowledge & Skills:

• People leadership skills

• Ability to effectively execute on cross-functional innovative projects in a complex operating environment

• Excellent verbal and written communication skills, including ability to speak comfortably and extemporaneously to diverse audiences

• Ability to explain program, clinical, operational, and quantitative information in a business-like, clear, coherent, and comprehensible way to lay people

• Strong quantitative and analytic skills working with claims, operational, and clinical data and reports

• Excellent interpersonal communication skills, including active listening, self-management and awareness, emotional intelligence, and ability to flex interpersonal style situationally

• Good skills with negotiation and creative solutioning

• Working knowledge/skills with Microsoft Office including Outlook, Word, Excel, and PowerPoint



Other requirement

• Reside, and able to travel frequently, in California