Executive Job Description | Morgan Consulting Resources is an executive search firm focusing on the Healthcare Industry for 15 years. We have extensive experience in bringing together leadership talent with organizations that cover all aspects of Healthcare Services - Providers, Payers and Supporting Service organizations. We have been retained to conduct a search for a Vice President of Quality Performance.
About the company:
Our client was founded in 1996 as an MSO with operations based in southern CA, offering services to providers of care. In 2005, they launched a Health Plan, a national provider of Medicare Advantage health plans. Through state or locally-branded health plans, they are focused on offering value-oriented Medicare health plan options to Medicare beneficiaries who reside in small to medium-sized communities that currently do not have affordable Medicare replacement plan options available. They are positioned to attain aggressive growth goals by end of 2010. As of January 1, 2010, the company will be in 15 states with over 60,000 Medicare Advantage lives.
About the position:
Based in southern California and reporting to the Chief Medical Officer, the VP we seek will be a seasoned leader with demonstrated skills in Health Plan Quality Improvement and Credentialing programs. Overseeing a staff of 16 in the Quality Department, the VP will be responsible for developing the Quality Improvement Plan in conjunction with the CMO. The position carries broad responsibility for leadership and management both internally and externally.
The entrepreneurial executive we seek will work collaboratively with Provider Relations, Finance, Medical Economics, Health Services, Customer Service and Compliance departments to design and implement QI projects in a fast moving and rapidly growing organization. We are looking for someone who can think strategically and also be able to “roll up their sleeves” and be involved in the details. He/she will be responsible for:
1. Overseeing and managing all aspects of the Medicare Star Rating program, including HEDIS, HOS and CAHPS reporting to improve scores;
2. Assuring the Plan meets or exceeds all CMS regulatory requirements and NCQA accreditation standards;
3. Effectively developing, communicating and implementing QI projects across the company; and,
4. Overseeing the Appeals and Grievance processes, including all CMS standards are continually met.
Experience with Government Funded Health Plans is a requirement (specifically Medicare Advantage Health Plan experience including HMO and POS processes). We are looking for a seasoned senior executive who can relate to staff at all levels.
If interested, or for a complete position description, please contact Rosie Saenz at rosie@morganconsulting.com.
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