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Job Details

Director, Quality Improvement

Requisition #: 188627
Location: Johns Hopkins Health Care, Hanover, MD 21076
Category: Nursing Management/Leadership
Work Shift: Day Shift
Work Week: Full Time (40 hours)
Weekend Work Required: Yes
Date Posted: Sept. 13, 2019

Johns Hopkins Health System employs more than 20,000 people annually. Upon joining Johns Hopkins Health System, you become part of a diverse organization dedicated to its patients, their families, and the community we serve, as well as to our employees. Career opportunities are available in academic and community hospital settings, home care services, physician practices, international affiliate locations and in the health insurance industry. If you share in our vision, mission and values and also have exceptional customer service and technical skills, we invite you to join those who are leaders and innovators in the healthcare field.

Responsible for the direction, development and coordination of all activities and functions of Quality Improvement division including: NCQA ® Health Plan Accreditation, compliance with regulatory quality improvement standards (Centers for Medicare and Medicaid Services (CMS), Defense Health Agency (DHA), Maryland Department of Health and Mental Hygiene (DHMH), ERISA and COMAR) , Member Satisfaction initiatives (CAHPS ®), HEDIS ® initiatives, Complaints and Grievances, Quality of Care audits, Member Safety program Quality Improvement initiatives, and VBP outreach unit. Directs program activities related to the design, establishment, implementation, and measurement and reporting for each Program within the department, including development of new quality improvement programs in accordance with regulatory and accreditation standards. Directs the Quality Improvement Work Plan, auditing process and data management including NCQA accreditation process, DHMH reporting and audit, Defense Health Agency (DHA) reporting and audits, CAHPS and Provider Survey analysis and interventions, oversight workgroups and committees including the quality improvement oversight Executive Committee (Medical Policy Committee), patient safety reporting and initiatives. Directs HEDIS data analytics and reporting, including those specific to STARS (Medicare Advantage) and Value Based Purchasing (VBP – Priority Partners) and related Outreach Activities, including Community Health Workers. Directs and reports Quality and Safety Improvement initiatives for JHHC, collaborating with Johns Hopkins Hospital and the Armstrong Institute.

  • Develop and monitor short/long term plans for quality improvement.
  • Develop strategies regarding Quality of Care improvement and Member Safety, in order to plan for effective and measurable interventions.
  • Direct the HEDIS/VBP Efforts for JHHC
  • Direct the VBP Outreach Process
  • Coordinate audits as required by regulatory or accreditation standards including the following: annual Delmarva Systems Review, Defense Health Agency required audits, CMS audits, HEDIS/ STARS Focused Medical Records Review, NCQA readiness, Member Satisfaction, Provider Satisfaction, and Complaints and Grievance Tracking and Auditing processes.
  • Oversee the development and management of data aggregation and formatting from various sources.
  • Direct QI Workgroup, Medical Policy Committee, PMT , VBP/HEDIS, Continuity and Coordination of Care workgroup and member satisfaction (CAHPS)/ Complaints and Grievance work groups

Requirements:

  1. Education:

Requires a Bachelor’s degree in health related field. Master’s degree in Health Administration or equivalent work experience preferred.

B. Knowledge:

Requires professional level knowledge of National Committee of Quality Assurance (NCQA), Healthcare Effectiveness Data and Information Set (HEDIS), the Delmarva Foundation for Medical Care Standards accreditation and review processes (DHMH) and Tricare/DOD.

C. Skills:

Requires strong analytical ability to solve complex problems. Must possess advanced interpersonal skills to effectively interface with all levels of staff as well as external business-related associates, auditing and accreditation agencies, and Executive Staff Expert at professional communication, required to persuade, gain cooperation, provide formal presentations to various sized groups including health care clinics, external auditors and regulatory agencies, and Executive Teams, to reach consensus and resolve conflict. Expert at professional writing in order to prepare reports/documents for internal presentations as well as presentation to various governance boards. Expert at workflow design. Advanced planning, organization, analytics and business acumen are required to understand and present the implications of various decisions.

Requires knowledge of Microsoft Office, Catalyst.

D. Required Licensure, Certification, Etc.:

If RN, active licensure as a Registered Nurse in the State of Maryland is required. Health Care Quality Certification preferred.

E. Work Experience:

Requires at least five years of nursing experience with training in the principles of Quality Management. Must have experience with conducting and monitoring the medical record review process. Must have coding and policy experience. Ten years’ management experience required.

Johns Hopkins Health System and its affiliates are drug-free workplace employers.

Johns Hopkins Health System and its affiliates are an Equal Opportunity / Affirmative Action employers. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity and expression, age, national origin, mental or physical disability, genetic information, veteran status, or any other status protected by federal, state, or local law.

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