RCM Health Care Services
Senior Director of Quality Performance Improvement
RCM Health Care Services, New York, New York, us, 10261
Position Summary
The Senior Director of Quality Performance Improvement will play a pivotal role in shaping and advancing the organization’s Quality Management strategy. Reporting to the VP of Quality Management, this leader will guide the design and implementation of the Quality Improvement (QI) workplan, lead clinical and non-clinical teams, and drive enterprise-wide quality performance—including oversight of HEDIS/QARR, CAHPS, HOS, CMS Star Ratings, and NYS DOH Quality Incentive programs. This is a highly strategic and hands-on leadership role responsible for provider engagement, regulatory compliance, and member experience improvement across all lines of business. Key Responsibilities
Partner with the VP of Quality Management to set and execute the vision for the Quality Improvement workplan. Serve as an internal expert on HEDIS/QARR, CAHPS, HOS, and CMS Star Ratings. Lead and develop cross-functional teams focused on improving performance in preventive care, chronic care, behavioral health, and member experience. Drive provider engagement initiatives to improve quality outcomes and close care gaps using data-driven strategies and coding best practices. Oversee and align quality initiatives with incentive-based programs (e.g., Member Rewards, Provider Pay-for-Performance, and Value-Based arrangements). Collaborate with the CAHPS Director to develop and execute line-of-business-specific strategies to improve member experience. Guide QI teams in identifying performance trends, conducting root cause analyses, and evaluating program impact using multi-source data streams. Lead compliance efforts related to: DOH Performance Improvement Projects (PIPs) Quality Matrices Medicare & UltraCare Chronic Care Improvement Programs (CCIP) Medicare & UltraCare Model of Care (MOC) Article 44 and Special Needs Plan audits Represent the organization in regulatory audits and external quality-related workgroups. Monitor and report progress to leadership, including the Quality Management and QAPI Committees. Stay current on quality measurement specifications, regulatory guidelines, and performance reporting standards. Requirements & Qualifications
Master’s degree in Public Health, Health Administration, or related clinical field required. 10 years of experience in healthcare or managed care; 5 years in a clinical setting preferred. Proven expertise in HEDIS/QARR, CAHPS, HOS, and CMS Star Ratings programs. Experience leading quality improvement and/or performance teams in complex healthcare organizations. Clinical license preferred (e.g., MD, NP, RN, PharmD, LMSW/LCSW). Strong analytical and data interpretation skills; background in statistics or data analysis is a plus. Proficient in Microsoft Office Suite, especially Excel, PowerPoint, and Access. Why Join This Team?
Make a measurable impact on the health outcomes of thousands of New Yorkers. Lead a mission-oriented team in a highly collaborative environment. Enjoy competitive compensation and robust benefits—including a pension plan, generous PTO, and opportunities for continued professional development. RCM Health Care Services
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The Senior Director of Quality Performance Improvement will play a pivotal role in shaping and advancing the organization’s Quality Management strategy. Reporting to the VP of Quality Management, this leader will guide the design and implementation of the Quality Improvement (QI) workplan, lead clinical and non-clinical teams, and drive enterprise-wide quality performance—including oversight of HEDIS/QARR, CAHPS, HOS, CMS Star Ratings, and NYS DOH Quality Incentive programs. This is a highly strategic and hands-on leadership role responsible for provider engagement, regulatory compliance, and member experience improvement across all lines of business. Key Responsibilities
Partner with the VP of Quality Management to set and execute the vision for the Quality Improvement workplan. Serve as an internal expert on HEDIS/QARR, CAHPS, HOS, and CMS Star Ratings. Lead and develop cross-functional teams focused on improving performance in preventive care, chronic care, behavioral health, and member experience. Drive provider engagement initiatives to improve quality outcomes and close care gaps using data-driven strategies and coding best practices. Oversee and align quality initiatives with incentive-based programs (e.g., Member Rewards, Provider Pay-for-Performance, and Value-Based arrangements). Collaborate with the CAHPS Director to develop and execute line-of-business-specific strategies to improve member experience. Guide QI teams in identifying performance trends, conducting root cause analyses, and evaluating program impact using multi-source data streams. Lead compliance efforts related to: DOH Performance Improvement Projects (PIPs) Quality Matrices Medicare & UltraCare Chronic Care Improvement Programs (CCIP) Medicare & UltraCare Model of Care (MOC) Article 44 and Special Needs Plan audits Represent the organization in regulatory audits and external quality-related workgroups. Monitor and report progress to leadership, including the Quality Management and QAPI Committees. Stay current on quality measurement specifications, regulatory guidelines, and performance reporting standards. Requirements & Qualifications
Master’s degree in Public Health, Health Administration, or related clinical field required. 10 years of experience in healthcare or managed care; 5 years in a clinical setting preferred. Proven expertise in HEDIS/QARR, CAHPS, HOS, and CMS Star Ratings programs. Experience leading quality improvement and/or performance teams in complex healthcare organizations. Clinical license preferred (e.g., MD, NP, RN, PharmD, LMSW/LCSW). Strong analytical and data interpretation skills; background in statistics or data analysis is a plus. Proficient in Microsoft Office Suite, especially Excel, PowerPoint, and Access. Why Join This Team?
Make a measurable impact on the health outcomes of thousands of New Yorkers. Lead a mission-oriented team in a highly collaborative environment. Enjoy competitive compensation and robust benefits—including a pension plan, generous PTO, and opportunities for continued professional development. RCM Health Care Services
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