The CountyCare Director of Population Health and Performance Improvement serves as a part of CountyCare Health Plan's leadership team responsible for meeting performance standards and targets set by the Centers for Medicare and Medicaid Services (CMS), the National Committee on Quality Assurance (NCQA), the Illinois Department of Family and Healthcare Services (HFS) and CountyCare. Develops and implements CountyCare's quality strategy and oversees the Quality Assessment and Performance Improvement (QAPI) Program. Drives Healthcare Effectiveness Data and Information Set (HEDIS), Consumer Assessment of Healthcare Providers and Systems (CAHPS) and other report card measurement and improvement. Leads committees and manages Quality Management staff and teams. Responsible for effective working relationships with internal and external stakeholders to improve quality of services and member outcomes.
Develops and implements all QAPI activities and strategic initiatives through the annual work plan, including analysis, PI projects and collaborative taskforces to meet or exceed targets.
In collaboration with the Medical Director, leads CountyCare's Quality Improvement Committee and its subcommittees.
Serves as an expert resource in quality measures and analysis and the performance improvement process.
Responsible for HEDIS, CAHPS, HFS quality reporting, quality of care investigations and medical record review programs including provider/peer review.
Oversees critical incident, grievance and appeals programs ensuring effective vendor performance and integration with all quality initiatives
Ensures accurate and timely analysis and distribution of quality data and reports to internal and external stakeholders.
Presents quality program performance, initiatives and achievements to varied audiences including Board committees, HFS, health plan leadership, providers and other stakeholders.
Develops and implements educational and corrective action activities for providers and vendors related to clinical quality and performance
Oversees and monitors QAPI activities delegated to medical groups and vendors.
Ensures effective relationships across sectors to advance the quality program goals.
Manages and mentors the staff toward achievement of organizational goals and objectives.
Oversees the technical interfaces with vendors and key partners to maximize data for the QAPI program.
Develops and implements policies and procedures.
Performs other related activities as assigned.
· Bachelor's degree from an accredited college or university
· Five (5) years of progressive management experience in health care including quality management
· Three (3) years of experience in managed care including a leadership position in quality management within a managed care organization or health plan
· Experience with HEDIS measures
· Experience with Health Plan accreditation
· Experience with Medicaid and medically underserved patient populations
· Licensed health professional in good standing in Illinois
· Master's Degree in Healthcare from an accredited college or university
· Certification in quality management
· Certification in project management
· Experience working with the patient centered medical home model of care delivery
· Experience with quality management for Medicare
· Experience working with integrated behavioral and physical health care services
Knowledge, Skills, Abilities and Other Characteristics
· Strong interpersonal skills; ability to establish strong working relationships and to communicate, effectively with leadership team, patients/members, primary care site leaders, physicians and clinicians, behavioral health team members and other care providers
· Strong leadership capability, problem-solving and organizational skills
· Demonstrated ability to drive improvement
· Excellent written and verbal communications skills
· Ability to communicate in a confidential and HIPAA compliant manner
· Ability to demonstrate respect and sensitivity for cultural diversity patients and coworkers
· Proficiency with Microsoft Office products (Word, Excel, PowerPoint, Outlook)
· Knowledge of the social determinants of health and interventions to provide effective health care to persons living in poverty
· Mission-focused and committed to underserved populations
When applying for employment with the Cook County Health & Hospitals System, preference is given to honorably discharged Veterans who have served in the Armed Forces of the United States for not less than 6 months of continuous service
To take advantage of this preference a Veteran must :
· Meet the minimum qualifications for the position.
· Identify self as a Veteran on the employment application by answering yes to the question by answering yes to the question,
Internal Number: 219200
About Cook County Health & Hospitals System
ABOUT COOK COUNTY HEALTH AND HOSPITALS SYSTEM
The Cook County Health & Hospitals System’s mission is to deliver integrated health services with dignity and respect regardless of a patient’s ability to pay; foster partnerships with other health providers and communities to enhance the health of the public; and advocate for policies that promote the physical, mental and social wellbeing of the people of Cook County.
CCHHS is comprised of two hospitals, John H. Stroger, Jr. Hospital and Provident Hospital, a robust network of more than a dozen community health centers, the Ruth M. Rothstein CORE Center, the Community Triage Center, the Cook County Department of Public Health, Cermak Health Services, which provides health care to individuals at the Cook County Jail and the Juvenile Temporary Detention Center, and CountyCare, a Medicaid managed care health plan.
The system cares for more than 300,000 patients each year and its physicians are experts in their fields, committed to providing their patients with comprehensive, compassionate and cutting-edge care. Today, CCHHS is transforming the provision of health care in Cook County by promoting community-based primary and preventive care, growing an innovative, collaborative health plan and enhancing the patient experience.