Sr. Director, Clinical Quality

Reporting to the VP, Quality, the role of the Sr Director is critical to the success of Blue Shield of California and the Clinical Quality department in realizing its goals and objectives. This individual will play a key role as part of the Quality team in delivering and collaborating on all aspects of quality outcomes. Responsible for the performance of all quality rating systems and for the development of strategic plans and programs to support continuous quality improvement. Developing, assessing, and delivering partnering on interventions, policies, and procedures at all levels and with critical operational departments to ensure quality programs will meet or exceed guidelines or requirements. Responsibilities Working with the VP, Quality, build out a detailed strategy to execute on multi-year quality plans which may include unique strategies for ACO, HMO, PPO and Medi-Cal delivery models. The quality plans will include staffing needs, infrastructure development, and partnering with other parts of the organization Manage a team of direct reports including several critical leaders and teams which deliver critical quality programs, models and operations Act as thought leader within BSC on methods to change member health behaviors and physician practice style that impact and improve quality outcomes Represent BSC on Quality at conferences and in statewide and national initiatives, and with state and federal regulators as necessary Evaluate and evolve current quality improvement and pay for performance programs using technology, member engagement strategies, partnerships with providers, incentives and other methods Partner with other BSC teams to enhance and customize programs to populations of members and providers Implement quality programs regional network specific strategy by working with internal and external organizations to disseminate and improve quality initiative uptake Develop and oversee provider incentive programs. Evaluate success of the programs and adjusting annually to drive outcomes. Oversee Medical Record Review and abstraction strategy and process Evaluate and Report Performance on Quality and Member Experience. Conduct program evaluations to inform revisions and refinements to interventions Ensure regulatory compliance and oversee audits Qualifications Minimum of 10 years of relevant experience required including 8 years of management experience Bachelor’s degree required in Nursing, Public Health, or other related field Master's degree in relevant field preferred Requires in-depth knowledge of quality, and change management processes Prior experience with total quality management, continuous quality improvement, and six sigma or lean methodology In-depth knowledge of NCQA, HEDIS process and specifications Ability to deliver a multi-year quality strategy About The Team As of January 2025, Blue Shield of California became a subsidiary of Ascendiun. Ascendiun is a nonprofit corporate entity that is the parent to a family of organizations including Blue Shield of California and its subsidiary, Blue Shield of California Promise Health Plan; Altais, a clinical services company; and Stellarus, a company designed to scale healthcare solutions. Together, these organizations are referred to as the Ascendiun Family of Companies. At Blue Shield of California, our mission is to create a healthcare system worthy of our family and friends and sustainably affordable. We are transforming health care in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience. Equal Employment Opportunity External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.

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