VP, Enterprise Quality, Strategy & Operations

Company :

Highmark Health

Job Description : 

JOB SUMMARY 

This job is  responsible for establishing the Highmark Health Quality, Safety & Value (QSV) Strategy & Operations plan aligned with organizational goals, regulatory requirements, and population health priorities. The incumbent is expected to ensure integration across the enterprise and to uphold the quality, safety, and value vision for our members and patients. The incumbent will work collaboratively across matrixed teams with Clinical and Quality Leadership at AHN, Highmark Health, and Highmark Inc. to drive and execute the quality strategy across the enterprise.. The incumbent will also champion a culture of excellence across our health plan and provider footprint, optimizing care delivery and financial performance while prioritizing patient safety and delivering exceptional value.

ESSENTIAL RESPONSIBILITIES 

• Develop and implement a comprehensive QSV strategy aligned with organizational goals, regulatory requirements, and population health priorities.
• Lead c cross functional initiatives to improve quality and optimize resource utilization across the continuum of care.
• Develop and maintain robust performance measurement and data analytics capabilities to monitor outcomes, identify areas of improvement and track progress against the enterprise goals.
• Proactively work with market and segment leaders and their teams to establish bi-directional feedback and maximize performance improvement activities.
• Lead the implementation of evidence-based practices and risk mitigation strategies across Highmark and the footprint provider landscape.
• Oversee and ensure compliance with quality regulations, including NCQA, HEDIS, CMS and state specific requirements.
• Foster collaboration and build strong relationships with multiple stakeholders at Highmark as well as clinical and quality leadership across our provider landscape to drive enterprise initiative performance.
• Effectively communicate QSV performance data and insights to internal and external stakeholders, including boards, regulators, and leadership teams.
• Monitor best practices and trends, proactively identifying and integrating solutions to optimize QSV performance.
• Works under the leadership of the Highmark health plan CMO to drive the evolution of the QSV Dashboard as the Living Health Strategy Evolves.
• Own the Clinical Data Strategy inclusive of interoperability requirements and use of artificial intelligence to facilitate electronic clinical data acquisition and value.
•  Collaborate proactively with dyad quality leaders across the organization.
• Ensures quality strategic framework is integrated into the enterprise Population Health Clinical Model Programming to demonstrate the wholistic achievement of better health outcomes.
• Ensures the business has the appropriate capabilities, people, processes, and technology in place to effectively execute.
• Serve as subject matter expert and consultant to the internal organization and providers in clinical quality matters.
• Identifies opportunities to streamline and rationalize redundancies across the organization. Responsible for achieving quality goals related to Centers for Medicare and Medicaid Services (CMS) STARS rating measures for both the Health Plan and AHN, in collaboration with the VP Government Quality and AHN quality leadership.
• Ensure development, maintenance, revision and promulgation of corporate medical policies, for all products and markets in accordance with regulatory requirements and in  support of overall quality goals and objectives (e.g. Medicare STARS).
• Lead and evolve teams responsible for internal quality audits and quality gap closure initiatives.
• Perform management responsibilities to include but are not limited to, hiring and termination decisions, coaching and development, rewards and recognition, performance management and staff productivity. Plan, organize, staff, direct and control the day-to-day operations of the department; develop and implement policies and programs as necessary; may have budgetary responsibility and authority.

EXPERIENCE 

Required 

• 10+ years in healthcare leadership with at least 5 years in a senior quality role within an integrated payer provider environment.
• Proven track record of success in leading and implementing QSV initiatives that deliver measurable improvement in QSV outcomes.
• Strong understanding of payer and provider perspectives and challenges.
• Demonstrated success in a dual role of Strategy & Execution
• Experience working with quality governing & regulatory bodies including but not limited to HEDIS and NCQA

 
Preferred 

• Integrated payer provider System Quality Experience
• Medical Policy Experience<