Healthcare & Clinical
Director, Quality Improvement (MA STARS)
Raleigh, NC, United States

It’s Time For A Change…

Your Future Evolves Here

Evolent Care Partners’ works directly with primary care organizations across the country to improve patient outcomes and reduce avoidable health care costs. We are a lean, nimble, and fast-paced team looking for innovators and disruptors with a passion for improving health care. Our team is made up of reliable, hard-working employees—each with a commitment to shaping our culture and strategy. This role presents a unique opportunity to get in on the ground floor of an internal start-up and leave your mark on health care.

Evolent Health has a bold mission to change the health of the nation by changing the way health care is delivered. Our pursuit of this mission is the driving power that brings us to work each day. We believe in embracing new ideas, testing ourselves and failing forward. We respect and celebrate individual talents and team wins. We have fun while working hard and Evolenteers often make a difference in everything from scrubs to jeans.

Are we growing? Absolutely. We have seen about 30% average growth over the last three years. Are we recognized? Definitely. We were named one of “Becker’s 150 Great Places to Work in Healthcare” in 2016, 2017, 2018 and 2019 and are proud to be recognized as a leader in driving important Diversity and Inclusion (D&I) efforts: Evolent achieved a 95% score on its first-ever submission to the Human Rights Campaign's Corporate Equality Index; was named on the Best Companies for Women to Advance List 2020 by; and we publish an annual Diversity and Inclusion Annual Report to share our progress on how we’re building an equitable workplace. We recognize employees that live our values, give back to our communities each year, and are champions for bringing our whole selves to work each day. If you’re looking for a place where your work can be personally and professionally rewarding, don’t just join a company with a mission. Join a mission with a company behind it.

Who You’ll Be Working With:

The Quality Improvement Director supports quality functions for Evolent Care Partners, managing the day to day of management of quality improvement programs that meet CMS and Commercial contract requirements; and (2) monitoring and improvement of clinical processes and outcomes under performance-based payment contracts. Working directly with the Senior Director of Performance & Quality, this role will play a key role with our performance advisors in creating infrastructure required for accountability and quality improvement purposes, as well as strategies for raising performance on national measures of population health management. For the ECP partners, the QI Director will drive the configurations, launch and ongoing operations of the Proactive Care program, suite of provider and patient engagement tools for identifying and closing important gaps in care for patient populations.

What You’ll Be Doing:

Proactive Care Program –

  • Identify and prioritize key quality and utilization measures critical to client success under its performance-based payment programs (e.g., achieving target thresholds for ACO Medicare Shared Savings Program, pay-for-performance contracts with national payers, etc.)
  • Work closely with Evolent Care Partners, Senior Director of Performance & Quality and Practice Performance Advisors to support care gap closure through physician practices, nurse care manager/pharmacist interactions, and patient communications and education
  • Introduce processes to track performance toward measurement goals, and based on findings, engage ECP leadership and partners on potential improvement interventions
  • Collaborate with Evolent Care partners leadership, Transformation Team, Clinical Informatics, internal IT and Reporting and Analytics to operationalize care gap closure efforts for the client
  • Coordinate with our Clinical Operations team (Care Advisors, CHWs, etc.) to leverage their expertise for care gap closure
  • Lead the End of Year Quality Reporting Activities with the operations team, monitor the accuracy of the submission and ensure an on-time delivery of CMS Web Interface Activities

Clinical Quality Programs –

  • Drive performance in quality programs/STAR ratings across multiple payer programs
  • Complete the tracking, trending, and reporting of internal and external quality management data for the performance team
  • Prepare and present reports for internal and external client committees (e.g., ACO Quality Committee)
  • Assist in activities to monitor and track ongoing compliance with CMS ACO MSSP quality program requirements
  • Manage the implementation and successful completion of the ACO’s quality improvement program

Commercial Payer Operations –

  • Drive relationships and analysis of performance in commercial payer programs
  • Co-Lead ongoing meetings including but not limited to, Joint Operating Committees (JOCs)

The Experience You’ll Need (Required):

  • >=7 years health care management experience with strong understanding of performance measurement and improvement processes (e.g., STAR/NCQA/HEDIS measures, CMS ACO measures, etc.)
  • Experience managing programs across Medicare Advantage, Commercial, MSSP programs
  • Track record of driving STAR rating improvement
  • Medicare Group Practice Reporting Option Web Interface (GPRO WI) reporting experience strongly desired.
  • Experience with preparing and analyzing Medicare ACO, HEDIS, and CAHPS data
  • Ability to work collaboratively with internal staff, payers, and physician practices on activities to improve population health management, health outcomes, and advance quality improvement initiatives
  • Experience driving initiatives for payer partnership Joint Operating Committees (JOCs)
  • Experience driving quality/STARs performance in Medicare Advantage Programs
  • Administrative experience in a health care or managed care environment and project management experience preferred

Finishing Touches (Preferred):

  • CPHQ certification or equivalent
  • Knowledge of Continuous Quality Improvement principles, CMS requirements and regulations, and ACO quality reporting.
  • Excellent analytical, verbal, written, organizational and interpersonal skills.
  • Proficiency with Microsoft Office applications and data management reporting.

Technical requirements:

Currently, Evolent employees work remotely temporarily due to COVID-19. As such we require that all employees have the following technical capability at their home: High speed internet over 10 MBPS and, specifically for all call center employees, the ability to plug in directly to the home internet router. These at-home technical requirements are subject to change with any scheduled re-opening of our office locations.

Evolent Health is an equal opportunity employer and considers all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, or disability status.

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