Director, Delivery System Quality Improvement

Today's healthcare industry -- dynamic and changing at a fast pace. Recruiting talented people can mean the difference between success or failure. At Blue Cross and Blue Shield of Massachusetts, our record of achievement represents a history of hiring the best people we can find, and then challenging them to excel. It's the kind of environment that enables us to give our best to the consumers we serve, and at the same time, work to the potential of those who work for us. Blue Cross Blue Shield of Massachusetts is an Equal Opportunity Employment/Affirmative Action Employer. Applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, veteran status, disability, sexual orientation, or any other characteristics protected by law.The Director, Delivery System Quality Improvement (DSQI) is responsible for establishing and maintaining relationships with hospitals, ancillary facilities and group practices to engage hospital executives and clinical leaders in performance improvement activities and incentives that improve the quality and safety of healthcare for BCBSMA members and ultimately, for all Massachusetts consumers of healthcare services. The Director, Delivery System Quality Improvement provides subject-matter expertise related to state and national measures of healthcare quality and quality improvement metrics. Through data analysis, a knowledge of evidence-based medical practices and a knowledge of hospital operations, works with hospitals to identify Quality Improvement (QI) opportunities. The Director, Delivery System Quality Improvement supports and represents the Director, Hospital Performance Measurement and Improvement (HPMI) internally and externally as needed and may serve as the Director, HPMI in their absence .Responsibilities Participation in measurement strategy development for hospitals, medical groups and other components of the delivery system Provide thought leadership on developing trends and tools in the Performance Measurement community Build and maintain strong, effective working relationships with hospital and physician group senior leaders and related community and advocacy organizations Provide content expertise regarding BCBSMA's hospital quality incentive programs to a portfolio of network hospitals Provide guidance and support to hospitals and ensure contractual deadlines are met Partner with BCBSMA Provider Contracting staff to educate hospital senior leadership (CEO/CFO, VP, Medical Affairs, Directors of Quality, Directors of Contracting) regarding hospital quality incentive programs. In collaboration with the Medical Directors, negotiate the clinical elements of the hospital incentive programs; review performance data, identify opportunities for improvement and obtain consensus and agreement on identified opportunities. Manage contractual obligations related to hospital quality incentive programs including tracking, collection, and review of data and deliverables. Partner with and provide subject-matter expertise to Provider Contracting, Provider Relations, Legal, Regional Medical Directors and other internal stakeholders in the implementation of hospital pay for performance and other related initiatives Develop and implement mechanisms for the dissemination of QI information and the sharing of best practices across network hospitals and physician groups. Provide leadership to actively engage physician groups in improving the clinical quality of care including the identification of opportunities for improvement, rapid cycle performance improvement principles and the sharing and adoption of evidence-based practices. Provide subject-matter expertise on state and national hospital and physician quality measures to internal and external customers. Ensure corporate compliance with NCQA standards pertinent to areas of responsibility. Lead cross-divisional workgroups charged with evaluation and improvement of the quality of care and ensure corporate compliance with relevant accreditation and regulatory standards as needed. RN or other licensed, clinical professional in the state of Massachusetts BS/BA required; Advanced degree preferred (MS, MHA, MPH, MBA, MA) 7-10 years broad clinical experience including 3 years experience in managed care Minimum of 3 years experience in Quality Management in an analytic capacity with emphasis on transforming data into actionable results Strong knowledge of national and state clinical quality programs, measures, and QM tools and techniques Familiarity with all generally available measurement sets for delivery system quality improvement, including, but not limited to AHRQ, CMS/JCAHO, NQF/LeapFrog, HEDIS, Rand, and Wennberg Knowledge of healthcare delivery systems, provider reimbursement methodologies, and provider incentive systems. Experience with Microsoft Office software Position Information Location:  02215 Job Category:  Medical/Health Reference Code:  bcbs-00001919 Our commitment to building a diverse workplace is without question. We are an Equal Opportunity Employer.