OneMain Financial Jobs

**Hybrid: Applicants must be a California resident as of their first day of employment.

PRINCIPLE RESPONSIBILITIES:

Under the general direction of the Senior Director, Quality, the Director, Quality Performance is responsible for developing, coordinating, implementing, and managing the strategic quality performance programs across multiple lines of businesses including Medi-Cal, Dual Eligible Special Needs Program (D-SNP), and Group Care). This role will work cross-functionally to implement quality initiatives to achieve state and national benchmarks for National Committee for Quality Assurance (NCQA) Healthcare Effectiveness Data and Information Set (HEDIS), Centers for Medicare and Medicaid (CMS) Star Ratings, Department of Health Care Services Medi-Cal Managed Care Accountability Set, and Department of Managed Health Care (DMHC) Health Equity and Quality Measure Set. The Director, Quality Performance is expected to collaborate with internal teams, provider networks, and with senior clinical leadership to drive initiatives and ensure oversight of medical management in accordance with regulatory requirements, accreditation standards, clinical outcomes, and member experience

Principle responsibilities include:

Develop and execute a comprehensive quality performance strategy, aligned with regulatory requirements, in partnership with the Director, Star Strategy and Program Management and QI Medical Director

Design and implement programs to improve HEDIS, CAHPS, and Star Ratings performance, ensuring alignment with NCQA, CMS, and DHCS standards

Oversee and maintain a robust data-driven quality measures program by developing dashboards and reporting tools to track quality performance of targeted initiatives, identify gaps, and inform decision-making

Monitor and report on quality measure performance and initiatives to Quality Improvement Committees and relevant sub-committees

Develop innovative strategies to improve and sustain HEDIS, CAHPS, and Star Ratings performance through on-going engagement with internal stakeholders, provider networks, members, and community partners

Develop or maintain policies and procedures, standard operating procedures, and trilogy documents (i.e. program description, workplan, evaluation) for the D-SNP Quality Management program

Work cross-collaboratively with clinical teams to review, update, and implement the D-SNP Model of Care

Partner with clinical leadership for coordination and administrative oversight of clinical responsibilities to ensure compliance with regulatory requirements and accreditation standards

Provide operational oversight of quality improvement processes including site visits, quality monitoring activities for skilled nursing or long-term care facilities, and medical chart audits

Serve as a resource for the design and evaluation of process improvement plans/quality improvement plans, and ensure they meet Continuous Quality Improvement (CQI) methodology and state contractual requirements

Ensure compliance with CMS, DHCS, and other relevant regulatory agencies by maintaining up-to-date knowledge of quality and performance measurement standards

ESSENTIAL FUNCTIONS OF THE JOB:

Assumes responsibility and exercises good judgement in making decisions within the scope of authority of the position. Proficient in understanding the NCQA technical specifications as it relates to HEDIS measures and their impact to Star ratings methodology. Demonstrates strong organizational, time management, and project management skills and multi-tasking abilities. Proven track record of developing and implementing successful HEDIS and member experience interventions with a focus on improving Star ratings. Provides support to the Project Management Office (PMO) and various enterprise-wide activities based on availability. Organizes and facilitates HEDIS, Stars, quality improvement, project-related meetings, as necessary. Works effectively independ ntly as well as part of a team and supports team decisions. Adapts to changes in requirements/priorities for daily and specialized tasks. Produces accurate and precise work, detects discrepancies, and resolves discrepancies all while meeting deadlines. Demonstrates analytical skills and problem-solving skills as well as formulates and communicates recommendations for improvements as needed.

PHYSICAL REQUIREMENTS:

Constant and close visual work at desk or computer.

Constant sitting and working at desk.

Constant data entry using keyboard and/or mouse.

Frequent use of telephone headset.

Frequent verbal and written communication with staff and other business associates by telephone, correspondence, or in person.

Frequent lifting of folders and various other objects weighing between 0 and 20 lbs.

Frequent walking and standing.

Occasional driving of automobiles.

Number of Employees Direct Supervision: 3-10

Number of Employees In-Direct Supervision: 10-15

MINIMUM QUALIFICATIONS:

EDUCATION OR TRAINING EQUIVALENT TO:

**

Masters degree in a health care field (i.e. nursing, health sciences/administration) strongly preferred.

Requires a BA/BS in a health care field (i.e. nursing, health sciences)

MINIMUM YEARS OF ADDITIONAL RELATED EXPERIENCE:

Minimum of 7-10 years of experience in management roles in a health care setting, including at least:

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3 years of quality leadership and management experience in a managed care health plan setting.

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