Director of Quality Improvement

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The Company:

AlohaCare is a local, non-profit health plan serving the Medicaid and Medicare dual eligible population. We provide comprehensive managed care to qualifying health plan members through well-established partnerships with quality health care providers and community-governed health centers. Our mission is to serve individuals and communities in the true spirit of aloha by ensuring and advocating access to quality health care for all. This is accomplished with emphasis on prevention and primary care through community health centers that founded us and continue to guide us as well as with others that share our commitment. As Hawaii’s third-largest health plan, AlohaCare offers comprehensive prevention, primary and specialty care coverage in order to successfully build a healthy Hawaii.

The Culture:
AlohaCare employees share a passion for helping Hawaii’s most underserved communities. This passion for helping and caring for others is internalized and applied to our employees through a supportive and positive work environment, healthy work/life balance, continuous communication and a generous benefits package.

AlohaCare’s leadership empowers and engages its employees through frequent diversity, recognition, community, and educational events and programs. AlohaCare has a strong commitment to support Hawaii’s families and reinforces a healthy work/home balance for its employees. Because AlohaCare values honesty, respect and trust with both our internal and external customers, we encourage open-door, two-way communication through daily interactions, employee events and quarterly all-staff meetings. AlohaCare’s comprehensive benefits package includes low cost medical, dental, drug and vision insurance, PTO program, 401k employer contribution, referral bonus and pretax transportation and parking program.

These employee-focused efforts contribute to a friendly, team-oriented culture which is positively reflected into the communities we serve.

The Opportunity:
The Director of Quality Improvement provides strategic leadership for Quality and Performance Improvement Program (QAPI), Population Health, NCQA Accreditation, and Appeals & Grievance in alignment with AlohaCare’s mission and strategic priorities for MedQUEST and Medicare lines of business. The QI Director’s primary responsibility is operating a management infrastructure that promotes or ensures member safety and quality of care, positive gains in population health; fulfillment of NCQA standards; efficient processes in appeals and grievance, and contractual compliance. The QI Director is accountable for creating a culture that is member-centered, integrated, collaborative, inter-disciplinary, data-driven, transparent, innovative, team-oriented, training committed, and sound in managed care fundamentals. The QI Director is mindful and committed to the AlohaCare Model of Care. He/She reports to the Chief Medical Officer.

Primary Duties and Responsibilities:

• Developing and implementing AlohaCare’s QAPI, Quality & Performance Improvement program Description, QI Work Plan, and Performance Improvement Projects (PIP);
• Improving AlohaCare’s Star Ratings and MedQUEST quality outcomes through innovative approaches in engaging members and providers;
o Efficient collection and reporting of HEDIS, CAHPS, HOS, and other required data;
• Leading and overseeing organizational wide adherence to NCQA standards and successful re-accreditation;
• Investigating quality issues in health services to ensure objective, thorough, inter-disciplinary, and compliant resolution and communication;
• Directs strategic initiatives in population health, including disease management and EPSDT, integrated in AlohaCare’s Model of Care;
• Serves on standing committees of governance and management; minimally, the following:
o Staff for the AlohaCare Board of Directors Committee on Quality;
o Member, Executive Council;
o Vice-chair and principal staff, Corporate Quality Improvement Committee (CQIC);
o Member, Corporate Compliance Committee;
o Staff, Practitioners Advisory Committee;

• Develops a team that collaborates, communicates, and coordinates within the QI Department and with other departments throughout the organization;
o Develops his/her Managers in leadership and management capability, building on their individual talents and passion to serve the AlohaCare’s mission.

• Ten years of previous successful senior leadership in Quality Improvement/Quality Assurance for a health care entity, preferably in health insurance required.
• Master’s Degree in Health Administration, a clinical discipline, or related field required. Extensive, directly relevant experience can be substituted; Certified Professional in Healthcare Quality (CPHQ) strongly preferred
• Sound understanding and skills in quality improvement processes and tools.
• Sound data analysis skills.
• Capable of developing effective working relationships with staff at all levels in the organization, and with network providers, committee members, and members of the AlohaCare Board of Directors.
• Ability to define problems, collect data, establish facts, and draw valid conclusions.
• Ability to work with mathematical concepts such as probability and statistical inference, and ability to apply concepts such as fractions, percentages, ratios, and proportions to practical situations.
• Ability to interpret an extensive variety of technical instructions and deal with several abstract and concrete variables.
• Able to communicate effectively both verbally and in writing; strong writing and presentation skills required.
Preferred Requirements

• Knowledge and experience of health insurance and Medicaid and Medicare regulations are highly desirable.
• At least five years of previous successful leadership in Quality Improvement/Quality Assurance for a health care entity, preferably in health insurance.
• Certified Professional in Healthcare Quality (CPHQ) strongly preferred
Mental, Physical and Environmental Demands:

• Sedentary Work: Exerting up to 20 pounds of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time.
• Inside working conditions
• No environmental hazards
• Requires operation of general office equipment to include PC

AlohaCare is committed to providing equal employment opportunity to all applicants in accordance with sound practices and federal and state laws. Our policy prohibits discrimination and harassment because of race, color, religion, sex (including gender identity or expression), pregnancy, age, national origin, ancestry, marital status, arrest and court record, disability, genetic information, sexual orientation, domestic or sexual violence victim status, credit history, citizenship status, military/veterans status, or other characteristics protected under applicable state and federal laws, regulations, and/or executive orders.

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