Essential Duties and Responsibilities

• Lead quality improvement programs and performance initiatives that support organizational goals and patient outcome improvements.
• Develop, implement, and monitor quality management strategies using evidence-based improvement methodologies.
• Analyze quality, operational, financial, and population health data to identify trends, improvement opportunities, and organizational performance gaps.
• Oversee value-based care programs, including Medicare Advantage, MSSP, ACOs, commercial value-based contracts, bundled payment arrangements, and pay-for-performance initiatives.
• Develop strategies to maximize quality incentives, shared savings opportunities, and overall contract performance.
• Partner with physicians and clinical leaders to improve quality metrics, HEDIS measures, STAR Ratings, MIPS performance, patient satisfaction, and clinical outcomes.
• Create and maintain provider performance scorecards and dashboards to support accountability and performance improvement.
• Lead population health initiatives focused on chronic disease management, preventive care, care gap closure, annual wellness visits, transitions of care, and patient engagement.
• Identify high-risk patient populations and collaborate with care teams to implement targeted intervention strategies.
• Ensure compliance with CMS, NCQA, Joint Commission, HIPAA, and other regulatory and accreditation requirements.
• Coordinate quality reporting, regulatory submissions, and documentation related to quality performance programs.
• Collaborate with coding and clinical documentation teams to improve risk adjustment accuracy, RAF scores, and documentation integrity.
• Monitor utilization, readmissions, emergency department utilization, total cost of care, and quality outcomes to support organizational goals.
• Facilitate quality committees, performance review meetings, root cause analyses, and corrective action planning.
• Support care coordination programs designed to improve patient outcomes, reduce avoidable utilization, and enhance continuity of care.
• Develop annual quality work plans, performance objectives, and strategic initiatives aligned with organizational priorities.