Director, Quality Improvement

Company: Medica
Location: Minnetonka
Posted on: May 6, 2025

Job Description:

DescriptionThe incumbent is responsible for setting the strategy and assuring implementation of the plan for clinical programs focused on data collection, analysis and leading improvement initiatives for HEDIS, star ratings, retrospective risk adjustment and education, and government audits requiring medical record review. The Director interfaces with all departments within Medica, external vendors and providers, state and federal regulators, advocacy groups and members. The incumbent sets the strategy and direct improvement initiatives to meet program goals that yield measurable outcomes.
Key Accountabilities:
Development & Execution of Quality measurement & improvement program strategy

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• Sets the strategy and directs the development and execution of quality measurement and improvement programs in support of market segments and regulatory and accreditation requirements that are performance-based, measurable and results-oriented
  
• Sets the strategy and directs development and execution of member and provider education designed to effectively improve Medica's quality program results
  
• Directs star program level communications with CMS
  
• Provides subject matter expertise on Star & HEDIS measures and improvement efforts across Medica, including financial and regulatory impacts
  
• Collaborates with all departments at Medica to collectively improve performance on quality measures
  
• Directs development and execution of product specific action plans for improvement of quality measures
  
  Execution of governmental audits
  
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  • Oversees the execution of government audits requiring medical record reviews including plan development, execution and communication to stakeholders
    
  • Assures the highest quality audits are conducted and required timelines are met.
    
    Budget & Resource Management
    
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    • Oversees management of annual budget for the Quality Measurement & Improvement area
      
    • Provides analysis, justification and management of investments in support of dynamic and changing regulatory and accreditation requirements around quality programs
      
    • Champions investments and prioritization of Quality Improvement intervention strategy to ensure the highest possible quality program results
      
      Talent Management & Functional Development
      
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      • Builds and shapes a highly-effective Quality organization by hiring, training, motivating and setting leadership direction for direct reports and key cross-functional team members that support Medica's quality strategy
        
      • Manages day-to-day team responsibilities and workload while anticipating future operating model needs, maximizing team resources and skill sets
        
      • Works with staff members to develop annual goals, measure progress against the goals and perform the annual performance review process to support overall segment objectives
        
      • Defines and nurtures a collaborative and customer-oriented culture among direct team and cross-functional relationships
        
      • Acts as a mentor to others
        
        Minimum Qualifications:
        
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        • Bachelor's degree or equivalent experience in related field
          
        • 10 years of related work experience beyond degree
          
        • 5-8 years of leadership experience preferred
          
          Preferred Certifications:
          
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          • CPHQ or Lean Certified
            
            Skills and Abilities:
            
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            • Experience with financial modeling in a healthcare context
              
            • Demonstrated knowledge of project management principles, methodologies, and best practices
              
            • Familiarity with Medicare Advantage reimbursement structures
              
            • Working knowledge of Medicare guidance review and interpretation
              
            • Understanding of technical specifications behind CAHPS, HOS, Stars, NCQA, and HEDIS measures
              
            • Demonstrated understanding of quality theory, data collection, analysis and study design; ability to track and display data; ability to design, implement and evaluate interventions
              
            • Proven track record of developing and implementing quality strategy and new programs to include innovative value based methodologies.
              
            • Demonstrated ability to analyze metrics, summarizes key business learning, and translate into tactical plans
              
            • Demonstrated ability to lead, influence change, initiate and shape work with colleagues inside and outside the organization to achieve goals
              
            • Proven ability to communicate effectively with all levels within the organization.
              
            • Direct experience meeting Regulatory/Medicare requirementsExcellent strategic thinking and analytical skills
              
            • Ability to understand and use data to facilitate decision making
              
            • Critical thinking skills to understand cause and effect relationships and conduct root cause analysis
              
            • Proficiency in developing communication strategies for a wide array of audiences that support strategic objectives
              
            • Demonstrated leadership with teams and peers
              
            • Ability to build effective collaborative partnerships, build alliances and gain consensus to drive results
              
              
              This position is an Office role, which requires an employee to work from the designated office - Minnetonka, MN, or Madison, WI - , on average, 2+ times per week.
              The full salary range for this position is $111,200 - $190,600. Annual salary range placement will depend on a variety of factors including, but not limited to, education, work experience, applicable certifications and/or licensure, the position's scope and responsibility, internal pay equity and external market salary data. In addition to base compensation, this position may be eligible for incentive plan compensation in addition to base salary. Medica offers a generous total rewards package that includes competitive medical, dental, vision, PTO, Holidays, paid volunteer time off, 401K contributions, caregiver services and many other benefits to support our employees.
              The compensation and benefits information is provided as of the date of this posting. Medica's compensation and benefits are subject to change at any time, with or without notice, subject to applicable law.
              We are an Equal Opportunity employer, where all qualified candidates receive consideration for employment indiscriminate of race, religion, ethnicity, national origin, citizenship, gender, gender identity, sexual orientation, age, veteran status, disability, genetic information, or any other protected characteristic.
              
              
              Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
              
              This employer is required to notify all applicants of their rights pursuant to federal employment laws.
              For further information, please review the notice from the Department of Labor.

Keywords: Medica, Eau Claire , Director, Quality Improvement, Executive , Minnetonka, Wisconsin