Immediate Start! Senior Director of Quality Performance Improvement
Company: MetroPlusHealth
Location: New York City
Posted on: July 2, 2025
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Job Description:
Job Description Job Description Empower. Unite. Care.
MetroPlusHealth is committed to empowering New Yorkers by uniting
communities through care. We believe that Health care is a right,
not a privilege. If you have compassion and a collaborative spirit,
work with us. You can come to work being proud of what you do every
day. About NYC Health Hospitals MetroPlusHealth provides the
highest quality healthcare services to residents of Bronx,
Brooklyn, Manhattan, Queens and Staten Island through a
comprehensive list of products, including, but not limited to, New
York State Medicaid Managed Care, Medicare, Child Health Plus,
Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc.
As a wholly-owned subsidiary of NYC Health Hospitals, the largest
public health system in the United States, MetroPlusHealth network
includes over 27,000 primary care providers, specialists and
participating clinics. For more than 30 years, MetroPlusHealth has
been committed to building strong relationships with its members
and providers to enable New Yorkers to live their healthiest life.
Position Overview: Empower. Unite. Care. MetroPlusHealth is
committed to empowering New Yorkers by uniting communities through
care. We believe that Health care is a right, not a privilege. If
you have compassion and a collaborative spirit, work with us. You
can come to work being proud of what you do every day. The Senior
Director of Quality Performance Improvement will participate in
developing the vision and strategic direction for the Quality
Management department. This position will work with the VP of
Quality Management to design and execute the organization’s quality
improvement (QI) workplan and serve as a subject matter expert for
HEDIS/QARR, CAHPS and HOS metrics, the NYS Department of Health
(DOH) Quality Incentive Awards and CMS Star Ratings Program. The
Senior Director has direction of a cross-functional team of
clinical and non-clinical staff responsible for improving quality
performance in preventive care, chronic care, behavioral health and
member experience in all lines of business. This position will be
the primary driver of the Plan’s quality-based provider engagement
strategy and provide clinical oversight of quality improvement
interventions for members and providers. The Senior Director of
Quality Performance Improvement is also responsible for oversight
of timely and satisfactory completion of regulatory projects and
programs such as the Department of Health (DOH) Performance
Improvement Projects (PIP) & Quality Matrix, the Medicare &
UltraCare Chronic Care Improvement Project (CCIP) and support of
the Medicare & UltraCare Model of Care (MOC). Participation in
product line related audits pertaining to clinical and operational
quality metrics are also under the purview of this role, such as
Article 44 and Special Needs Plan Model of Care audits. Job
Description - Participate in the development of the vision and
strategic direction for Quality Management; works with the VP of
Quality Management in the design and execution of the
organization’s quality improvement (QI) workplan and serves as a
HEDIS/QARR/STARS, CAHPS and HOS subject matter expert. - Manage and
lead cross-functional team to develop strategies, implement action
plans, and oversee ongoing operational executions to meet corporate
business goals for healthcare quality performance and cost
containment. - Drive the Plan’s quality-based provider engagement
strategy to close gaps-in-care and improve risk scores. Collaborate
with network providers to ensure quality improvement projects are
clinically sound, care is consistent with HEDIS/QARR requirements
(including coding practices) and auxiliary data streams are
established, if needed. - With the CAHPS Director, design and
execute an organization-wide, line-of-business specific quality
improvement (QI) strategy for CAHPS metrics. Drives
MetroPlusHealth’s goal to provide top-tier experience to members
through data-driven improvement activities and interdepartmental
collaboration - Assists in the identification and alignment of
quality measures selected for the MetroPlus Member Rewards Program,
Provider Pay for Performance Program and Value-Based Programs with
the regulatory quality incentive programs driving towards incentive
maximization and continued improvement in member health outcomes. -
Leads the QI team’s efforts to identify improvement areas,
understand marketplace and member/provider behaviors, research
member/provider barriers and validate them within the population,
develop predictive models, perform root-cause analysis, and
evaluate program effectiveness for quality performance metrics.
Synthesizes multiple data streams for clinical and CAHPS metrics to
identify high-risk members. - Identify process improvement
opportunities and provide guidance and direct oversight to automate
processes, implement efficiencies, or execute needed changes. -
Maintain up-to- date knowledge and understanding of
HEDIS/QARR/CAHPS measure technical specifications and CMS Star
Rating measures, including HOS & Operational measures. -
Responsible for regulatory oversight of DOH Performance Improvement
Projects and Matrices, the Medicare & UltraCare Chronic Care
Improvement Project (CCIP) and the Medicare & UltraCare Model of
Care (MOC), as well as any product line-related audits pertaining
to clinical and operational quality metrics. - Convene and lead
work groups with external vendors and internal staff in support of
quality measure improvement. - Oversee evaluation of the
effectiveness of interventions, dashboards, and operational
performance indicators to better assess the organization’s ability
to meet quality targets. Track and report on initiative progress at
all appropriate levels of the organization, including Quality
Management Committee and Quality Assurance and Performance
Improvement Committee. Minimum Qualifications - Master’s degree in
public health, health administration, and/or clinical field. - 10
years’ experience in healthcare or managed care industry. 5 years’
experience in a clinical setting is a plus. - Strong
analytical/quantitative skills. Background in statistics and/or
data analysis is a plus. - Extensive experience and knowledge with
HEDIS/QARR/CAHPS/HOS, CMS Star Ratings. - Proficiency in Microsoft
Office (Word, PowerPoint, Excel, Access). - Clinical license (MD,
NP, RN, PharmD, LMSW/LCSW etc.) with 5 years clinical experience
preferred. Professional Competencies: - Team Building and
Leadership - Integrity and Trust - Customer Focus -
Functional/Technical skills - Written/Oral Communication
Keywords: MetroPlusHealth, Waterbury , Immediate Start! Senior Director of Quality Performance Improvement, Healthcare , New York City, Connecticut