Premera Blue Cross Director of Quality in Mountlake Terrace, Washington

Join Our Team: Do Meaningful Work and Improve People’s Lives

Our purpose, to improve customers’ lives by making healthcare work better, is far from ordinary. And so are our employees. Working at Premera means you have the opportunity to drive real change by transforming healthcare.

The Director of Quality will develop and implement Premera’s Quality strategy and all programmatic components. In this role, you will be responsible for the oversight of Medicare Advantage (MA) Star Ratings, ensuring effective operations for, and improvement of, Healthcare Effectiveness Data Information Set (HEDIS) and Consumer Assessment of Healthcare Providers and Systems (CAHPS) scores. In addition, you will maintain National Committee for Quality Assurance (NCQA) accreditation, Quality of Care processes, Quality Committee direction and support, Member and Provider Engagement, and improve overall quality of care for its members.

In collaboration with Premera’s Healthcare Economics, Integrated Health Management, and Provider Network Management, this role establishes results-oriented strategies that help Premera achieve its quality, growth, and financial targets. The Director of Quality is a key contributor to the Company's financial, operational, and strategic business objectives related to Quality and plays a key leadership role both inside and outside of Premera. This experienced leader will provide guidance for the development and growth of a Quality Team, plus demonstrating effective communication and team building abilities,

What you’ll do

  • Develop and lead strategy development, implementation and associated operations for improving quality scores to achieve company objectives and align with the Company’s Purpose.
  • Achieve the goals of the Premera Quality Program by ensuring: NCQA accreditation is maintained and goals for level of accreditation are met. Ensure; goals for Marketplace QRS Stars are met and maintained for each market; MA Star rating goals are achieved and maintained. Achieving and maintaining HEDIS and CAHPS targets are key components for meeting these goals.
  • Ensure all Quality programs are in compliance and meet or exceed industry standards set by accrediting, regulatory, or other agencies. Report status and results of Quality Program activities to applicable committees and internal leadership teams.
  • Support Premera’s Healthcare Delivery System team in developing and executing provider-facing strategies for achieving Premera’s Quality goals.
  • Respond to complaints regarding Quality of Care, ensuring appropriate action plans are executed; which may include but are not limited to, notification of Premera’s Provider Credentialing Committee, hospitals and state medical quality assurance bodies.
  • Lead preparation for third party audits; serve as the point of contact during audits and drive resolution of open items after the audit.
  • Develop annual Quality Program budget and maintain accountability for meeting budget.
  • Develop and update the Quality Trilogy documents, consisting of the annual Quality Improvement Program Description, Evaluation and Work Plan. Manage the preparation and execution of all components related to the Premera Quality Improvement Committee (PQIC).
  • Attract and retain talented professionals. Adhere to Premera’s stated Values and provide ongoing coaching and development for team members. Build and maintain a collaborative, cohesive, and highly functional team of Quality professionals.
  • Work closely and collaboratively with the Risk Adjustment team, understanding the inherent connection points between Quality and Risk Adjustment, from both a practical and theoretical perspective, while serving the needs of our customers.

What you’ll bring

  • Bachelors’ degree in Business or Healthcare, or four years’ work experience
  • Ten years of health plan, health network or healthcare administration quality program experience including:
  • Five years’ experience managing teams
  • Five years’ experience delivering improvement results through programs such as NCQA, HEDIS, CAHPS, Medicare Stars or similar quality improvement programs.
  • Excellent leadership communication skills with the ability to articulate strategy execution and influence stakeholders to engage in issues that impact quality of care and reducing health care costs.
  • Advanced degree such as a MBA, MHA, MPH. and experience with regulatory and accrediting compliance of a health plan are preferred

What we offer

Premera is proud to offer a comprehensive benefits package including:

  • Medical, vision and dental coverage
  • Life and disability insurance
  • Retirement programs (401K employer match and pension plan)
  • Wellness incentives, onsite services, a discount program and more
  • Tuition assistance for undergraduate and graduate degrees
  • Generous Paid Time Off to reenergize
  • Free parking

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Job Title: Director of Quality

Job ID: 11801

Location: Mountlake Terrace, WA

Full/Part Time: Full-Time

Regular/Temporary: Regular

Equal employment opportunity/Affirmative action

Premera is an equal opportunity / affirmative action employer. Premera seeks to attract and retain the most qualified individuals without regard to race, color, religion, national origin, gender or gender identity, sexual orientation, age, genetic information, disability or veteran status. All staff of Premera and its subsidiary companies must demonstrate the legal right to work in the United States. Premera is an E-Verify employer.