Director, Quality DES

Overview

Under the direction of the Executive Director of Disability Evaluation Services (DES) and in collaboration with other senior and executive staff, the Director of Quality provides quality management leadership and strategic direction for DES to support the Massachusetts Medicaid Disability Determination program and other programs as directed by the Executive Director. A member of the DES executive team, the Quality Director is responsible for the oversight and strategic development of a comprehensive quality program and is accountable for quality assurance and compliance activities, focusing efforts on outcomes that will resolve program deficiencies and enhance the disability supplement process for both external and internal parties, most notably the main customer of the program (MassHealth disability applicants). This position will direct and execute internal and external quality assurance reviews, determine key performance improvement priorities, identify risks, and develop and implement process improvement plans, while ensuring integrity of all disability determination activities and support services are incompliance with contract terms and appropriate policies and regulations. This role promotes a continuous improvement environment and serves as a change-maker to augment DES' current performance to ensure it stays up-to-date with applicable technologies and processes that enhance the existing disability determination services process.

Responsibilities

Oversees the development and maintenance of the DES quality strategy and data-driven quality program for the Disability Determination contract for MassHealth and other programs as needed, as directed by the DES Executive Director.Leads an operational quality management structure and framework for performance and continuous improvement to maintain an effective, compliant quality program.Oversees a quality management team to support the quality management structure .Establishes framework for DES project work to align with the quality management structure, including governance model for program oversight and monitoring.Leads development of criteria and methodologies consistent with program goals to evaluate the accuracy of the process and outcome of disability determinations. Partners with the MassHealth Disability and Eligibility Advocates to ensure any concerns and/or disability applicant feedback is addressed appropriately and as applicable, included in a process improvement initiative.Directs and monitors data collection, reporting and trending activities relating to program compliance activities.Leads the data team related to quality data, analysis and reporting, and ensuring continued improvement of internal and external reports and data visualizations where applicable.Recommends and supports the implementation and ongoing management of software related to data collection and reporting.Oversees development of a sustainable comprehensive quality scorecard with key performance indicators (KPIs) to support leadership in determining priorities.Provides guidance to all operational teams within DES to identify areas of opportunity and collaborate with them to drive evidence-based initiatives.Leads educational trainings, as needed, to DES staff on data analysis and interpretation.Works collaboratively with technology partners to implement necessary system changes as part of process improvement solutions.Directs and conducts random sample assessments of disability determinations, targeting general areas of improvement and the accuracy and quality of reviews conducted by disability review staff.Collaborates with appropriate DES staff to assist in the development and presentation of training initiatives designed to improve accuracy and quality of the review process.Oversees analysis of information, data and DES operational staffs' recommendations and prepares reports to clients regarding quality assessment. Will drive content and assist with all client facing deliverables.Directs the reviews and evaluation of both operational and clinical performance and ensures utilization of program datato draw conclusions and make appropriate recommendations.Partners with DES leaders to develop training curriculums for clinical and operations units to ensure the provision of services as outlined in the contract scope of service.Serves as a subject matter expert in relevant federal and state regulations and DES policies and procedures for internal DES clinical and operations staff.Oversees the quality framework that ensures DES complies with all required federal and state program regulations and reporting requirements, and proposes changes to program regulations, policies and other documents where applicable.Performs other duties as assigned/needed.

Qualifications

REQUIRED EDUCATIONBachelor's Level Degree in a health-related field or equivalent.REQUIRED WORK EXPERIENCE7 - 9 years of related professional experience in quality (measurement and improvement); experience in health-related setting.5 - 7 years of experience in process and performance improvement and training.Demonstrated success in designing and implementing effective quality and quality improvement related projects.Lean Six Sigma Green Belt.Ability to develop innovative and feasible solutions to problems of unusual complexity that require a high degree of ingenuity, creativity, and innovation.Provide leadership in a dynamic team environment. Ability to persuade and facilitate issue resolution.Demonstrated experience in computer based tools, including spreadsheets, database management, and word processing.Strong organizational skills and attention to detail.Excellent written and verbal communication and influencing skills, with the ability to tailor messages to all levels of internal/external audience.Must be willing to learn the complete Massachusetts Medicaid disability determination program process.Demonstrated commitment to and experience with computer-based tools.PREFERRED EDUCATIONMaster's Level Degree or equivalent in a health-related field or equivalent.PREFERRED WORK EXPERIENCELean Six Sigma Black Belt.Experience in interpreting and applying disability determination regulations. Strong operational experience in working with large, diverse groups.Prior experience developing and/or delivering training curriculums and quality assurance programs.