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The Director of Quality Improvement is responsible for overseeing and directing quality improvement initiatives within MedStar Family Choice. They develop and implement strategies to enhance the quality of care, improve health outcomes, and ensure compliance with regulatory standards. The role collaborates with cross‑functional teams, healthcare providers, and external stakeholders to drive continuous quality improvement and promote a culture of excellence in healthcare delivery.
Primary Duties and Responsibilities
Leads the development and implementation of a comprehensive quality improvement strategy aligned with MedStar Family Choice goals and objectives.
Identifies key areas for improvement, sets measurable objectives, and establishes performance metrics to monitor progress and outcomes.
Directs and oversees quality improvement initiatives across the health plan, including HEDIS, EPSDT, NCQA, and EQRO accreditation.
Collaborates with cross‑functional teams to develop action plans, implement interventions, and monitor performance against quality targets.
Utilizes advanced data analytics and healthcare informatics to analyze healthcare data, identify trends, and drive performance initiatives.
Develops and maintains comprehensive reports, dashboards, and scorecards to track quality metrics, performance trends, and improvement opportunities.
Prepares and analyzes special reports such as CAHPS, EPSDT Provider Satisfaction Annual Technical Report, SPR Performance Improvement Projects (PIPS), Value Based Purchasing (VBP), and Encounter Data Validation.
Oversees and supervises annual quality audits performed by the external quality review organization (EQRO) and NCQA HEDIS, EPSDT Encounter Validation, Data Network Adequacy Validation, and System Performance Review.
Lead efforts to continuously evaluate and improve quality improvement processes, tools, and methodologies based on industry best practices and organizational needs.
Fosters a culture of continuous improvement by encouraging innovations, soliciting feedback, and empowering staff to take ownership of quality improvement initiatives.
Coordinates and conducts studies for the various quality measures required by state regulatory guidelines and NCQA; evaluates member and provider satisfaction and makes modifications as necessary to improve satisfaction.
Provides training, education, and support to internal staff, healthcare providers, and network partners on quality improvement methodologies, performance measurement, and regulatory requirements.
Facilitates learning opportunities and knowledge‑sharing sessions to promote awareness, understanding, and adoption of quality improvement best practices.
Assists with organizing the agenda and actively participates in Quality Improvement Committee meetings and other departmental and state meetings as directed; oversees the preparation and distribution of agendas and minutes for committee meetings.
Develops department goals, objectives, policies, and procedures; ensures compliance with business unit policies and procedures, and governmental and accreditation regulations.
Supervises and monitors the effectiveness of contracted vendors who assist with outreach, wellness, member/enrollee service, and quality efforts; oversees the development of a Corrective Action Plan when goals are not met.
Oversees the development and delivery of meaningful real‑time provider scorecards to MFC’s participating providers to educate, inform, and assist them in achieving MFC’s goals and objectives; assists with MedStar Medical Group’s quarterly POD meetings to deliver Provider Scorecards and perform face‑to‑face provider education on MFC’s QI program.
Works collaboratively with the Information Systems Team and Senior Data Analyst to develop reports to meet the department’s annual objectives; uses technology to enhance decision‑making and effectiveness.
Oversees the development, implementation, and revision of wellness and preventative care programs, goals, and interventions; ensures that each area meets targeted goals as determined by regulatory jurisdiction such as Value Based Purchasing (VPB), EOSDT, and HEDIS.
Identifies target populations, geographic areas, and key stakeholders to prioritize outreach efforts and maximize impact.
Minimal Qualifications
Education
Bachelor’s degree in a healthcare field (BSN preferred).
Master’s degree in a healthcare field preferred.
Experience
5‑7 years of quality improvement experience within a health plan, preferably a managed care organization (MCO).
3 years of supervisory experience with system development and implementation.
5‑7 years of diverse clinical experience.
Licenses and Certifications
RN – Registered Nurse – State Licensure and/or Compact State Licensure (Valid RN license in the local area serving, e.g., State of Maryland or District of Columbia); preferred upon hire.
CPHQ – Certified Professional in Healthcare Quality certification; preferred upon hire.
Knowledge, Skills, and Abilities
Knowledge of current trends in health care delivery and population management.
Knowledge of NCQA HEDIS, EQRO audits, and local regulatory guidelines preferred.
Strong analytical, technical writing, problem‑solving, and independent judgment skills.
Business acumen and leadership skills.
Excellent verbal and written communication skills with ability to interact with all levels of management and external agencies.
Proficiency with Microsoft Office applications, especially Word, Excel, and PowerPoint.
Ability to enter and retrieve information using a PC.
Working knowledge of various computer software applications.
Salary Range
USD $111,779.00 – $212,513.00 per year.