Gainesville, Georgia
Pompton Plains, New Jersey
Durham, North Carolina
Posted: 12-Apr-25
Location: Dallas, Texas
Categories:
Internal Number: 25006048
Position Overview:
The Director of Quality Analytics & Audit will lead all quality analytics, reporting, and audits for the Baylor Scott & White Health Plan across Medicare, Medicaid, Commercial and Exchange populations.
The Director will be responsible for collaboration with leadership teams, medical directors, and external partners to assess and implement strategies that enhance quality, improve outcomes, and meet regulatory requirements in programs including the National Committee for Quality Assurance (NCQA) accreditation (including ownership of the full NCQA HEDIS Quality audit cycle), Texas Health and Human Services Commission (HHSC), Centers for Medicare and Medicaid Services (CMS), and Texas Department of Insurance (TDI).
Finally, the leader will be part of the team responsible for coordinating with external agencies and governing bodies, such as NCQA and CMS. Develop and communicate quality analytic business plans and department goals to meet operational, financial, and service requirements in accordance with overall business objectives.
Open to considering hybrid applicants who can travel occasionally to Texas.
Primary Responsibilities:
- Strategic Leadership & Operations Management: Translates and implements strategic plans for the area of responsibility, ensuring alignment with organizational goals. Makes final operational decisions, recommends policies and organizational changes, and directs projects to meet annual objectives. Manages staffing, processes, budgets, with supervision of 5-10 direct reports.
- Quality Analytics & Data Strategy: Leads quality analytics initiatives to support quality improvement programs. Develops and executes data strategies for analyzing quality metrics, including claims, pharmacy, and EMR data. Ensures accurate and timely delivery of all quality regulatory reporting (NCQA, CMS, and state-specific requirements).
- Compliance & Regulatory Oversight: Ensures compliance with NCQA accreditation standards, identifying areas for improvement and enhancing compliance strategies. Research regulations, advises senior leadership on necessary actions, and provides updates on compliance activity. Leads preparation for audits, surveys, and regulatory reviews.
- Innovation & System Integration: Supports the implementation of software, tools, and automation capabilities to improve data integration and reporting processes. Leads data profiling and system integration testing, with a focus on quality data solutions.
- Collaboration & External Engagement: Serves as a representative to external quality and data organizations (CMS, NCQA, State Medicaid Agencies). Fosters partnerships to enhance quality improvement efforts by working closely with internal stakeholders, including leadership and medical directors, to assess needs and drive improvement initiatives.
Preferred Qualifications:
- Strong experience in health plan analytics leading an organization, creating strategic plans, and operationalizing functional teams in direct relation to meeting business needs or realizing goals tied to strategic objectives.
- Exceptional knowledge and experience with HEDIS, CAHPS, NCQA, Medicare Star Rating System, Marketplace QRS, and Medicaid State Reporting.
- Understand and develop pioneering approaches (advanced analytics) to emerging industry trends by remaining curious, passionate about learning, and a proactive problem solver that brings innovative ideas and solutions to business problems
- Preference given to candidates with advanced degrees (Masters, PhD.), advanced analytic skills (Phython, R), experience in large insurance companies, and those knowledgeable of Snowflake, Cotiviti, Epic, and HealthRules/Guiding Care.
Why Join Us? At Baylor Scott & White Health, you'll play a key role in improving healthcare outcomes through data-driven insights and impactful quality initiatives. Join us and make a difference!
QUALIFICATIONS
- EDUCATION - Bachelor's or 4 years of work experience above the minimum qualification
- EXPERIENCE - 5 Years of Experience