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VP Quality | RN

St. Louis, MO

VP Quality | RN

Job Description

VP, QUALITY - MCO - St Louis

EXCEPTIONAL leadership team - GENEROUS Relocation

Working closely with the Chief Medical Director and the CEO, VP will oversee all related activities for Quality Improvement functions. Lead and direct process improvement activities for more efficient and streamlined workflow. Oversee the business processes related to risk adjustment and quality improvement for assigned products and plans.

Responsible for all activities related to National Committee for Quality Assurance (NCQA) Accreditation and/or Healthcare Effectiveness Data and Information Set (HEDIS) performance ensuring highest level of accreditation


Review and implement new technological tools and processes and foster team concept with internal and external constituencies


Present results of improvement efforts and ongoing performance measures and recommend actions plans to senior management


Research and incorporate quality improvement best practices into operations


Organize and control activities, methods, and procedures to achieve business objectives


Formulate and establish policies, operating procedures, and goals in compliance with internal and external guidelines


Manage and ensure compliance of EPSDT program as well as compliance and turnaround time of grievances and appeals



Job Requirements

Qualifications:

- Bachelor's degree in Nursing 

- Master's’ degree preferred. 

- Must be a SME in HEDIS and QI process

-10+ years of health plan/MCO/ACO operations experience, including QI and NCQA accreditation. 

- Experience managing acquisition and integration of external data sources. 

-Proven leadership experience including responsibilities for hiring, training, managing performance.

- Experience with succession planning and EI a plus

- Familiarity with running Risk Adjustment prospective and retrospective programs preferred

- RN license preferred (not required)

- CPHQ preferred (not required)

About MMS Group

MMS is a Managed Care executive search firm. We are Managed Care's complete recruiting resource.

Keywords: nurse executive jobs, leadership jobs in healthcare, nurse executive role, nursing leadership and management jobs, nurse executive jobs near me, cphq jobs, nurse executive jobs in st. louis, healthcare quality improvement jobs

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