Vice President Chief Quality Officer – Philadelphia, PA

The French Group has been retained by our client, an award-winning not-for-profit health plan, to identify a talented physician executive to serve as their first Chief Quality Officer.

Job Summary

The VP & Chief Quality Officer (CQO) role is a newly created position within the health plan and will focus on the government sector. This is a highly collaborative and strategic role requiring substantial experience as a physician leader in the QI space. The CQO will provide the strategic vision and leadership to drive innovative quality and performance improvement initiatives and operational efficiencies across the enterprise. The CQO will oversee the development of clinical strategies including the development clinical programs and population health initiatives. In concert with other members of the clinical leadership team, the CQO will be responsible for systems and process redesign and the implementation of evidenced-based best practices. Additionally, the CQO is responsible for oversight of accreditation, HEDIS, STARS and ensuring compliance with CMS and other applicable regulatory agencies. The CQO will also be involved in the development of quality measures for new value- based payment models.

The CQO will oversee a team of QI Medical Directors and the Clinical Quality team. The CQO reports to the EVP, an energetic, collaborative leader and clinician with significant expertise in health plan operations.

Primary Responsibilities

  • Provide clinical expertise towards the development of strategic, operational and tactical clinical programs designed to improve the overall health of the population
  • Provide leadership, clinical oversight and guidance to maintain the highest levels of service quality.
  • Provide direction for risk adjustment activities and revenue maximization.
  • Recruit, develop, motivate and manage high caliber QI Medical Directors and management staff
  • Maintain a positive work environment that supports self-directed initiatives; provide a structure to optimize the skill, knowledge and capability of Medical Directors and the management team.
  • Develop and maintain collaborative relationships with regulatory agencies such as DPW, DOH, NCQA, CMS, etc. to ensure that all protocols and procedures are consistent with regulatory requirements.
  • Build consensus and maintain collaborative alliances with internal and external customers.
  • Manage budget and control expenses while meeting goals and objectives.
  • Participate in the development of appropriate benchmarks for quality key indicators
  • Provide Clinical input to the development of profiling and monitoring programs related to the quality of medical services provided by participating providers
  • Provide advice and counsel on medical and clinical matters related to the Plan.
  • Participate in the strategic planning and operational decision making of the Company.
  • Provide Clinical staffing support and input to the Medical Affairs Committee of the Board of Directors.
  • Participate in collaborative efforts to partner with risk owner hospital medical, care management, administrative, and financial staff to establish and enhance clinical programs and maximize revenue.

Requirements

  • MD or DO with active, unrestricted Pennsylvania medical license plus MBA/MPH desirable
  • Current board certification in ABMS recognized specialty; primary care preferred
  • 5+ years of successful leadership experience of a health plan Quality Improvement department and performance excellence in a managed care environment
  • Demonstrated leadership in STARS, HEDIS and NCQA with demonstrated success in taking an MCO through CMS, State, and NCQA audits/site visits.
  • 5+ years Managed Care Medical Director experience, preferably in Medicare/Medicaid plans
  • 5+ years successful experience in developing and managing a Clinical Quality team and associated operating budget is highly preferred.
  • 5 years’ experience working as a part of cross-functional, self-directed teams is preferred.
  • Strong working knowledge of global trends and involvement with national QI organizations
  • Exceptional communication and presentation skills
  • Ability to balance service provision with cost containment.
  • Knowledge of health care economics.
  • Broad Medical Director expertise encompassing utilization management, case and disease management, and quality.
  • Experience in developing and analyzing care management programs that have demonstrated both clinical and financial improvements in a managed care setting.
  • Strategic mind with strong independent decision making ability.
  • Inspirational leadership style with exceptional staff development, team-building and mentoring skills.

For additional information and/or confidential consideration, please contact:

Tricia French, RN, BSN
President & CEO
The French Group
757-362-0202
tfrench@frenchgroup.com