VP, Quality and Clinical Program Oversight

Morgan Consulting Resources, Inc. has been retained to conduct the search for the Vice President of Quality & Clinical Program Oversight for BMC HealthNet Plan. The Vice President reports directly to the Chief Clinical Officer and will be responsible for overseeing quality for the organization’s 430,000 members. This is an outstanding opportunity to join a growing organization with a very strong and committed senior leadership team who is deeply committed to the safety net and low income populations. This position is remote but requires occasional travel to the Boston office.

About BMC HealthNet Plan:
BMC HealthNet Plan is a nonprofit health plan that provides health insurance coverage to Massachusetts residents, including low income, underserved, disabled and elderly populations. We were established in 1997 by Boston Medical Center, the largest safety net hospital in New England, and have more than 20 years of experience delivering accessible care to complex populations. We also provide health coverage to Medicaid members in New Hampshire, where we operate as WellSense Health Plan. For more information about BMC HealthNet Plan, please visit: https://www.bmchp.org/.


Our Mission:
To serve Boston Medical Center and to assist and support its mission in providing and enhancing access to effective, efficient medical care among low income, underserved, disabled, elderly and other vulnerable populations.


Who We Serve:

Medicaid (MassHealth): Coverage for low income individuals, families and people with disabilities. We manage MassHealth benefits through two delivery models: our Accountable Care Organization partnerships and our Managed Care Organization, which includes the Special Kids Special Care program managed with the Department of Children and Families.
Qualified Health Plan (QHP): Coverage for individuals who obtain insurance on the Massachusetts Health Connector (the State Exchange or Marketplace). Some members qualify for subsidies based on their income.
Senior Care Options (SCO): Coverage for low-income and disabled seniors living in five counties throughout Massachusetts – Barnstable, Bristol, Hampden, Plymouth and Suffolk.
Medicaid (New Hampshire): Managed care model coverage for low-income individuals and families across the state of New Hampshire. Operates under the brand name WellSense in New Hampshire.
WellSense Medicare Advantage HMO: Recently launched and currently enrolling members in New Hampshire. This is a major growth and diversification channel for the organization.


Key Partnerships:

  • 17,900 primary care, specialists and behavioral health providers
  • 53 acute care hospitals
  • 4 MassHealth ACO partners
  • 92 community organizations
  • 25 community health centers


About Boston Medical Center:

Unwavering in its commitment to the community, Boston Medical Center is a private, not-for-profit, 514-bed, academic medical center located in Boston’s historic South End. The primary teaching affiliate for Boston University School of Medicine, Boston Medical Center is the largest safety net hospital and busiest trauma and emergency services center in New England.

 

About the Position:

The Vice President provides leadership for all activities relating to the development and management of the Plan’s quality improvement and accreditation activities including NCQA, contractual and regulatory quality requirements and measures for all lines of business, HEDIS and STARs Performance Improvement and clinical quality programs. The Vice President develops and oversees strategies, policies and processes to ensure implementation of programmatic initiatives related to these areas with both internal and external stakeholders.

We are looking for a seasoned quality management leader with strong STARs and HEDIS knowledge and a solid understanding and success with performance improvement, cost management and care management within the Medicaid and Medicare settings. The successful candidate will be collaborative, hands on and motivated to join a mission driven, provider-owned organization. The Vice President must approach this role with a high level of accountability, flexibility and initiative. The Vice President will establish a culture of quality and performance improvement while maintaining a strong focus on consumer satisfaction and provider engagement. The Vice President must be data driven and analytical. The ability to present complex data in a clear and concise manner to a variety of audiences is critical.


Key Functions & Responsibilities:

  • Designs, implements and leads the Plan’s continuous quality improvement infrastructure. Acts as an internal consultant and resource to all levels of the organization relative to CQI processes and standards. Keeps abreast of strategic operating priorities and corporate goals to ensure processes, plans and policies are designed to fulfill strategic objectives.
  • Demonstrates strong team leadership and communication skills, fostering an environment for development and collaboration.
  • As part of Senior Leadership, participates in the company’s strategic planning and provides Executive Leadership with timely and accurate information.
  • Leads all Plan activities for National Committee for Quality Assurance (NCQA) re-accreditation.
  • Responsible for the ongoing administrative, clinical, fiscal and programmatic interaction with NCQA. Communicates with NCQA as needed to ensure the Plan is informed of all events and circumstances that affect the initial and on-going achievement of NCQA accreditation.
  • Ensures compliance with contractual requirements relative to Quality Management / Quality Improvement.
  • Oversees quality of care studies (based on targeted areas for quality management and quality improvement). This includes the following: analyzes data, performs root cause analysis, facilitates plans for improvement, provides technical support to Plan managers, and conducts re-measurement activities to assess performance improvement.
  • Leadership in health plan’s quality performance initiatives and monitors quality performance indicators; prepares reports for quality oversight committees; develops vehicles to communicate performance to providers; and identifies clinical and administrative concerns for further investigation and analysis.
    Qualifications:

Education:

Bachelor’s degree in Health Care Administration, Public Health, Nursing, or related field or the equivalent combination of training and experience is required. Master’s degree in related field strongly preferred.

Experience/Competencies:

  • 10+ years of progressively responsible experience in leading Quality Improvement Programs, which includes supervision of staff and budget management, is required.
  • Comprehensive knowledge of Medicaid and MassHealth regulations, guidelines and standards is preferred.
  • Comprehensive knowledge of accreditation organizations such as NCQA is required.
  • Comprehensive knowledge of QM/QI standards, processes and metrics; including HEDIS, P4P, CAHPS, and CMS is required.
  • Previous experience in designing and leading an accreditation process is strongly preferred.

 

Licensure/Certification:

  • Active licensure as a Registered Nurse required.
  • CPHQ certification strongly preferred.

If you or someone you know has the qualifications for this role, I would love to set up a time to talk. Thank you so much for your time.

Lisa Coyne, Principal
Morgan Consulting Resources, Inc.
lisa@morganconsulting.com


POSITION DESCRIPTION

Position: Vice President, Quality and Clinical Program Oversight
Company: BMC HealthNet Plan
Reports to: Chief Clinical Officer
Location: Remote (requires occasional travel to the Boston office)

Job Summary:

Provides leadership for all activities relating to the development and management of the Plan’s quality improvement and accreditation activities including NCQA, contractual and regulatory quality requirements and measures for all lines of business, HEDIS and STARs Performance Improvement and clinical quality programs.

The Vice President develops and oversees strategies, policies and processes to ensure implementation of programmatic initiatives related to these areas with both internal and external stakeholders

Key Functions/Responsibilities:

  • Designs, implements and leads the Plan’s continuous quality improvement infrastructure. Acts as an internal consultant and resource to all levels of the organization relative to CQI processes and standards. Keeps abreast of strategic operating priorities and corporate goals to ensure processes, plans and policies are designed to fulfill strategic objectives.
  • Demonstrates strong team leadership and communication skills, fostering an environment for development and collaboration.
  • Additionally as part of Senior Leadership, participates in the company’s strategic planning and provides Executive Leadership with timely and accurate information.
  • Leads all Plan activities for National Committee for Quality Assurance (NCQA) re-accreditation.
  • Responsible for the ongoing administrative, clinical, fiscal and programmatic interaction with NCQA. Communicates with NCQA as needed to ensure the Plan is informed of all events and circumstances that affect the initial and on-going achievement of NCQA accreditation.
  • Responsible for overall Utilization Program Compliance as it pertains to accreditation obligations.
  • Ensures compliance with contractual requirements relative to Quality Management / Quality Improvement.
  • Oversees quality of care studies (based on targeted areas for quality management and quality improvement). This includes the following: analyzes data, performs root cause analysis, facilitates plans for improvement, provides technical support to Plan managers, and conducts re-measurement activities to assess performance improvement.
  • Leadership in health plan’s quality performance initiatives and monitors quality performance indicators; prepares reports for quality oversight committees; develops vehicles to communicate performance to providers; and identifies clinical and administrative concerns for further investigation and analysis.
  • Develops and manages communications with providers, government and accreditation organizations with respect to results of quality management studies, including oversight of remedial action as required.
  • Directs the supervision of subordinate staff to include hiring, work allocation, scheduling, training and professional development, problem resolution, performance evaluation and related supervisory activities. Maintains budgetary responsibility for responsible departments.
  • Serves as the Official Record Keeper of the Quality and Clinical Management Committee.


Supervision Exercised:

Directly manages 5-15 staff and indirectly oversees up to 40 staff.

 

Supervision Received:

General direction is received weekly.

 

Qualifications:

Education:
Bachelor’s degree in Health Care Administration, Public Health, Nursing, or related field or the equivalent combination of training and experience is required.

Preferred/Desirable:
Master’s degree in related field strongly preferred.


Experience:

  • 10+ years of progressively responsible experience in leading Quality Improvement Programs, which includes supervision of staff and budget management, is required.
  • Comprehensive knowledge of Medicaid and MassHealth regulations, guidelines and standards is preferred.
  • Comprehensive knowledge of accreditation organizations such as NCQA is required.
    Preferred/Desirable:
  • Experience within a managed care organization is strongly preferred.
  • Previous experience in designing and leading an accreditation process is strongly preferred.

 

Licensure, Certification or Conditions of Employment:

  • Active licensure as a Registered Nurse required.
  • Pre-employment background check.
  • CPHQ certification strongly preferred.


Competencies, Skills, and Attributes:

  • Comprehensive knowledge of QM/QI standards, processes and metrics; including HEDIS, P4P, CAHPS, and CMS is required.
  • Proven leadership skills and ability to build effective teams and direct the management of multiple, complex, high impact projects is required.
  • Outstanding oral and written communication skills.
  • Ability to build relationships and successfully interact with staff at all levels of the organization and with external constituencies.


Working Conditions and Physical Effort:

  • Regular and reliable attendance is an essential function of the position.
  • Work is normally performed in a typical interior/office work environment.
  • No or very limited physical effort required. No or very limited exposure to physical risk.
Position Description »