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St Louis, MO
Job Type
Direct Hire
Nov 12, 2018
Job ID

VP, QUALITY  - MCO - St Louis

        EXCEPTIONAL leadership team -  GENEROUS Relocation

Working closely with the Chief Medical Director and the CEO, VP will oversee all related activities for Quality Improvement functions. Lead and direct process improvement activities for more efficient and streamlined workflow. Oversee the business processes related to risk adjustment and quality improvement for assigned products and plans.

Responsible for all activities related to National Committee for Quality Assurance (NCQA) Accreditation and/or Healthcare Effectiveness Data and Information Set (HEDIS) performance ensuring highest level of accreditation

Review and implement new technological tools and processes and foster team concept with internal and external constituencies

Present results of improvement efforts and ongoing performance measures and recommend actions plans to senior management

Research and incorporate quality improvement best practices into operations

Organize and control activities, methods, and procedures to achieve business objectives

Formulate and establish policies, operating procedures, and goals in compliance with internal and external guidelines

Manage and ensure compliance of EPSDT program as well as compliance and turnaround time of grievances and appeals


- Bachelor's degree in Nursing 

- Master's’ degree preferred.

- Must be a SME in HEDIS and QI process

-10+ years of health plan/MCO/ACO operations experience, including QI and NCQA accreditation.

- Experience managing acquisition and integration of external data sources.

-Proven leadership experience including responsibilities for hiring, training, managing performance.

- Experience with succession planning and EI a plus

- Familiarity with running Risk Adjustment prospective and retrospective programs preferred

- RN license preferred (not required)

- CPHQ preferred (not required)