Chief Quality Officer

This position is exempt from the State Human Resources Act

This posting is for a pending vacancy, anticipated August 2024.

TELEWORK AVAILABILITY: We trust our employees to be self-motivated and successful in hybrid/remote roles; NC Department of Health and Human Services offers work from home options and variable work schedule flexibility for this position.

Division of Health Benefits employees with an approved hybrid telework schedule are currently expected to work onsite at their assigned duty station at least 4 working days per month or more as needed for business operations.  Telework options are subject to change at the discretion of management. More information on this arrangement may be obtained at the time of interview.

This position's duty station is assigned to Dix Campus in Raleigh, North Carolina. Occasional travel to meetings and conferences both statewide and out of state will be expected for this position.

Position Summary

The Chief Quality Officer (CQO) will report to NC Medicaid's Chief Medical Officer (CMO). This position is a member of the Division of Health Benefits Executive Team and will participate in other critical strategic matters such as business development, strategic planning, technology, and clinical integration to deliver on improved quality, outcomes and total medical expense (TME) outcomes for the Medicaid population. The purpose of this position is to be responsible for the overall direction, leadership and operational management of the quality programs for NC Medicaid. This leader will be fully integrated into the design, development and implementation of clinical and population health quality and evaluation for NC Medicaid to include coordination of stakeholders include meetings, briefings, presentations, logging of activity, managing expectations and coordination of feedback. Programmatic evaluation is inclusive of all Medicaid programs including Medicaid Direct, waiver services, managed care, and other initiatives as directed.

Job Specific Responsibilities

• Develop and implement the foundational strategy and change management that is necessary as the Medicaid balances growth and sustainability with the highest level of clinical and population health quality and evaluation to inform our programmatic direction and drive improved population health with a focus on driving health equity.

• Direct and implement evidence-based programs, practices and activities that realize continuous improvements in clinical quality.

• Oversee clinical quality data analytics, understand trends and direct the monitoring, reporting and active discussion of clinical outcomes among the areas where quality issues have been identified.

• Conduct research of literature and regulations in planning for policy development.

• Manage targeted processes, consultants, stakeholders, contractors etc. relative to the 1115 Medicaid Transformation and Innovations Waiver.

• Prepare white papers and other briefs based on research on Medicaid Managed Care, Waiver Populations, Integrated Physical and Behavioral Health and other policies.

• Interpret Federal and State healthcare programs relating to NC Medicaid Reform.

• Collaborate and communicate with key stakeholders on the strategic direction of current and future state of programs and services.

• Create and manage reports, presentations, documents, graphics and spreadsheets as required.

• Create an environment that fosters innovation and performance, supporting the implementation of programs that continuously advance clinical outcomes, member experience, and provider experience.

• Engage in personnel administration to include but not limited to recruiting, selecting, managing employees; delegating to staff members; encouraging and fostering professional development; establishing effective professional goals and work plan objectives.

To receive credit for all of your work history and credentials, you must list the information on the application form. Any information listed under the text resume section or on an attachment will not be considered for qualifying credit. Qualified applicants must document on the application that they possess all of the following:

• Broad knowledge of health insurance, operations, programs, policy, and procedure along with experience or insight into provider contracting and operations.

• Demonstrated experience in strategic program planning, implementation and management skills.

• Experience in comprehensive quality management, including quality planning, quality assessment and quality improvement.

• Experience in leading continuous quality improvement (CQI) initiatives, especially in areas related to health.

• Familiarity with use of Healthcare Effectiveness Data and Information Set (HEDIS) measures, Consumer Assessment of Healthcare Providers and Systems (CAHPS) measures, and various National Committee for Quality Assurance (NCQA) health plan accreditations and distinctions preferred.

• Experience communicating effectively with internal and external stakeholders.

• Strong critical thinking skills with the ability to manage complex situations, recognize and respond appropriately to various issues and highly sensitive and high-profile situations.

• Demonstrated ability to effectively prioritize and organize work, set clear objectives, and break large-scale projects down to milestone deliverables or outcomes.

• Experience with analyzing contracts, budgets, program data and information concerning program operations in order to evaluate effectiveness.

• Highly proficient in Microsoft Office, including Word, PowerPoint and Excel.

Management Preferences:

• Advanced quality management training.

• Familiarity with relevant and current NC Medicaid programs, preferably in the quality and care management areas.

• A clinical background is strongly preferred.

Some state job postings say you can qualify by an "equivalent combination of education and experience." If that language appears below, then you may qualify through EITHER years of education OR years of directly related experience, OR a combination of both. See oshr.nc.gov/experience-guide for details.

Master's degree in a discipline directly related to the agency's program, business administration or public administration from an appropriately accredited institution and seven years of program experience in the public or private sectors involving significant decision-making authority in the planning, organizing, and directing of operations in an area related to the assigned program(s), including four years in a supervisory capacity;

or

Bachelor's degree as indicated above from an appropriately accredited institution in an area related to the assigned program(s) and nine years of program experience in the public or private sectors involving significant decision-making authority in the planning, organizing, and directing of operations in an area related to the assigned program(s), including four years in a supervisory capacity;

Or an equivalent combination of education and experience, including four years in a supervisory capacity.

Degrees must be from appropriately accredited colleges or universities.

The North Carolina Department of Health and Human Services is an Equal Opportunity Employer.

Pre-employment criminal background checks are required for all positions with the Division of Health Benefits (DHB).

About NC Medicaid (Division of Health Benefits)

The North Carolina Department of Health and Human Services (NCDHHS) works closely with beneficiaries, health care professionals, community leaders and advocacy groups; local, state and federal entities; and other community partners vested to improve the health and safety of all North Carolinians by providing essential human services. NCDHHS is one of the largest, most complex agencies in the state, with about 17,000 employees.

The Division of Health Benefits (DHB) within NCDHHS is committed to advancing innovative solutions that improve health, promote well-being and foster independence for all North Carolinians. DHB manages and oversees North Carolina Medicaid, NC Medicaid Managed Care and other programs that provide access to services and supports for parents, children, seniors, people with intellectual / developmental disabilities, and behavioral health, substance use and traumatic brain injury disorders. With a budget over $21 billion in state and federal funds per fiscal year, DHB ensures that more than 96,000 enrolled providers are reimbursed for delivering covered services to 2.9 million beneficiaries.

Realizing the strength of DHB lies in its employees, DHB remains dedicated in its efforts to create and maintain a diverse, equitable and inclusive workplace environment.

Application Process

Applicants are encouraged to apply for positions of interest, regardless of their current grade level and job classification. A pay increase may or may not result. Salary decisions are based on relevant education and experience, budget, and internal equity.

To be under consideration for this vacancy, all applicants must complete an online application using this link: https://www.governmentjobs.com/careers/northcarolina. If multiple applications are submitted to an individual posting, only the most recent application received prior to the posting close date will be evaluated for consideration.

Due to the volume of applications received, we are unable to provide information regarding the status of your application. To check the status of your application, please log in to your GovernmentJobs.com account. You will either receive a call or email to schedule an interview or an email notifying you when the job has been filled. For technical issues with your application, please call the NeoGov Help Line at 855-524-5627.  If there are any questions about this posting other than your application status, please contact us at Medicaid.Recruitment@dhhs.nc.gov.