Looking for a way to make an impact and help people? Join PacificSource and help our members access quality, affordable care! PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, sex, sexual orientation, gender identity, national origin, genetic information or age. PacificSource values the diversity of our community, including those we hire and serve. We are committed to creating and fostering a work environment in which individual differences and diversity are appreciated, respected and responded to in ways that fully develop and utilize each person's talents and strengths. The Director of Quality Improvement Programs provides leadership and strategic direction for the Medicare STARs and Oregon Health Authority (OHA) Quality Incentive Metric (QIM) Programs, which are essential for driving member quality outcomes and revenue. This role is responsible for the strategic oversight, development and implementation of quality improvement strategies to achieve high performance and fostering a culture of continuous improvement and leadership development within the organization. Essential Responsibilities: * Lead and ensure accountability for the success of end-to-end Medicare STARs and Oregon Health Authority (OHA) Quality Incentive Metric strategy and performance. * Lead development, implementation, and evaluation of annual and multi-year work plans to support continuous quality improvement and achieve strategic goals. * Integrate quality strategies across programs to promote optimal organizational effectiveness and enhance performance. * Drive collaboration across the Quality team to lead development of business/financial cases for specific Quality initiatives. * Mitigate risk that could result in lost revenue, potential sanctions or penalties, and disadvantages relative to competitors, all associated with QI performance. * Collaborate with Health Services leadership to guide and inform quality support of provider payer partnerships including value based contracting strategies, sales, and product development. * Provide strategic insight and direction to program management team to communicate and advocate needs to internal stakeholders to drive creative solutions that meet the organizations STARs, QIM and Customer Assessment of Healthcare Providers and Systems (CAHPS) goals. * Lead Quality Program governance development and ongoing execution across measure level owners. * Provide strategic leadership for Quality Program Mangers to incorporates actionable analytics, utilizing business intelligence tools, care coordination reports and gap in care data to identify issues, mitigate risks, and develop solutions. * Partner with leadership and stakeholders to understand both critical and enhancement needs to develop, recommend, and establish strategies and processes aimed to improve operations, create efficiencies, enhance member experience, and drive quality outcomes. * Develop and monitor key performance Indicators (KPIs) across programs to ensure performance goals are on track, operations are compliance and metric ownership is upheld. * Proactively identify new quality incentive metric or programmatic changes, works with program management team to ensure processes and reporting are built out in advance of effective dates. * Coordinate business activities by maintaining collaborative partnerships with key departments. * Develop and monitor annual departmental budgets. * Actively participate in various strategic and internal committees to disseminate information, represent company philosophy, and preserve visibility within the community. * Guide department managers in QI program and personnel management responsibilities. * Participate in committees related to Quality and Performance Improvement, including the evaluation of improvement initiatives and reporting to executive management group. * Perform employee management responsibilities to include but are not limited to: involved in hiring and termination decisions, coaching and development, rewards and recognition, performance management and staff productivity. Supporting Responsibilities: * Meet department and company performance and attendance expectations. * Lead and/or support quality improvement activities, designated committees, and/or task forces to ensure delivery of quality, cost-efficient, high-quality member care. * Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information. * Perform other duties as assigned. SUCCESS PROFILE Work Experience: Minimum eight (8) years' experience in a managed care setting with a minimum of five (5) years of experience leading health plan quality programs required. Strong knowledge of CMS Stars, HEDIS, CAHPS, HOS, Medicaid Quality Metrics and Provider reimbursement mechanisms required. Minimum of four (4) years of leadership experience including managing direct reports/cross-functional teams and presenting to executive management required. Experience with health plan functions (Health Services, Operations and Provider Network) as well as experience with alternative payment methodologies, including value-based payment contracts required. Must have strong analytical and reporting experience. Education, Certificates, Licenses: Bachelor's degree in health care administration, nursing, public health, or related field required. Master's degree in health care administration, public health or related field preferred. Project Management Certification preferred. Knowledge: Extensive knowledge of quality program implementation and management, HEDIS, CAHPS, HOS, Medicare STAR Ratings, Medicaid Quality Metrics and Dual Special Need plans. Demonstrated skills in quality improvement concepts, healthcare data analysis, data mining methods and the identification of population health issues, trends, and health disparities using healthcare data sources. Strong data analytic skills and the ability to interpret/explain complex technical information to key stakeholders including senior leadership and executive management. Knowledge of quality improvement methodology, principles of adult learning and/or motivational interviewing. Knowledge/experience with quality improvement initiatives in the clinic setting including clinical quality outcomes and patient experience. Must have strong analytical skills and business acumen to interpret strategic vision into an operational model. Ability to lead with high motivation and strong interpersonal & communication skills (oral and written). Advanced level of proficiency in computer skills using Word, PowerPoint, and Excel with the ability to generate reports from multiple datasets. Competencies: Building Trust Building a Successful Team Aligning Performance for Success Building Customer Loyalty Building Strategic Work Relationships Continuous Improvement Decision Making Facilitating Change Leveraging Diversity Driving for Results Environment: Work inside in a general office setting with ergonomically configured equipment. Evening meeting attendance is required at least monthly. Travel is required approximately 10% of the time with some overnight travel. Skills: Accountable leadership, Business & financial acumen, Empowerment, Influential Communications, Situational Leadership, Strategic Planning Our Values We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business: * We are committed to doing the right thing. * We are one team working toward a common goal. * We are each responsible for customer service. * We practice open communication at all levels of the company to foster individual, team and company growth. * We actively participate in efforts to improve our many communities-internally and externally. * We actively work to advance social justice, equity, diversity and inclusion in our workplace, the healthcare system and community. * We encourage creativity, innovation, and the pursuit of excellence. Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively. Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.