Director of Quality Improvement, Member Experience, & Health Equity

Job description

Lead the strategy. Improve outcomes. Advance health equity. Transform the member experience. Health New England is seeking an accomplished and forward-thinking Director, Quality Improvement, Member Experience & Health Equity to provide strategic and operational leadership across our Medicare, Medicaid, and Commercial lines of business. This is an opportunity to shape how quality, member experience, health equity, and clinical performance come together to create better outcomes for the communities we serve. RESPONSIBILITIES : Reporting to the Vice President, Chief Medical Officer , the Director of Quality Improvement, Member Experience, & Health Equity will drive enterprise-wide strategies that improve clinical quality, member satisfaction, health equity, regulatory performance, and accreditation results. A key differentiator of this role is the opportunity to collaborate closely with Baystate Health, leveraging the integrated health plan/provider relationship to connect health plan quality priorities with clinical delivery. You’ll help advance data sharing, care-gap closure, provider performance, value-based care, and coordinated improvement initiatives — helping make the payvider model a true competitive advantage. Enterprise Quality, Member Experience & Health Equity Strategy Develop and execute enterprise-wide strategies, annual work plans, goals, and performance measures across Quality Improvement, Member Experience, and Health Equity. Establish strategic priorities aligned with organizational objectives. Lead quality improvement and member-centered performance initiatives. Chair or co-chair quality, health equity, member experience, and related governance committees. Partner with the Chief Medical Officer and executive leadership to improve clinical outcomes, member satisfaction, and operational effectiveness. Present performance results, opportunities, and recommendations to Executive Leadership, Quality Committees, and Board Committees. Oversee quality audits, corrective action plans, regulatory reporting, and continuous improvement initiatives. Medicare, Medicaid & Commercial Quality Provide strategic oversight across multiple lines of business while translating complex performance data into focused improvement strategies. Improve Medicare Advantage Star Ratings. Advance Medicaid ACO quality outcomes. Optimize HEDIS, CAHPS, HOS, preventive care, and care-gap performance. Meet state, CMS, NCQA, and Commercial quality requirements. Partner with clinical, operational, and vendor teams to address measure-specific opportunities. Support growth and retention through exceptional quality and member experience. Health Equity & Accreditation Serve as an executive champion for health equity and help embed equitable care and service principles throughout the organization. Lead the ongoing achievement and maintenance of NCQA Health Equity Accreditation , including: Health equity governance and strategy. Disparity identification and reduction. Demographic and disparity-related data collection and analysis. Health equity dashboards, goals, and reporting. Regulatory and accreditation readiness. Strategies to improve access, clinical outcomes, and member experience across populations. Provider Quality & Value-Based Care Build strong partnerships with Provider Network Management, Population Health, Baystate Health, and network providers to improve quality and outcomes. Improve provider quality performance. Advance value-based care and provider incentive programs. Improve preventive care and chronic disease management. Strengthen care coordination and member engagement. Identify provider performance opportunities and implement targeted interventions. Data, Analytics & Quality Infrastructure Lead the teams and infrastructure responsible for transforming complex healthcare data into meaningful quality improvement opportunities. Health equity data collection, including RELD, SOGI, and SDOH data. HL7/CCD clinical data acquisition and processing. Standard Supplemental Data Files and NCQA audit readiness. EMR access and medical record availability. Member experience data collection. Annual Medical Record Review activities. Quality Improvement Analytics. HEDIS measurement and reporting. Population Health Needs Assessments and annual program evaluations. ECDS performance optimization through SSDF, HL7, CCD, and medical record data. SCHEDULE: Full-time Monday through Friday No weekends, no holidays LOCATION: 1 Monarch Place Springfield, MA Hybrid work opportunity – 3 days a week on-site required – candidate must live in MA or CT QUALIFICATIONS : Master’s degree in Healthcare Administration, Nursing, Public Health, Business Administration, or a related field, required 7–10 years of progressive healthcare leadership experience, required At least 5 years of leadership experience in health plan quality improvement, accreditation, member experience, population health, or a related discipline, required Demonstrated experience with Medicare Advantage, Medicaid, and Commercial health insurance products. Strong knowledge of Medicare Star Ratings, HEDIS, CAHPS, HOS, and value-based care models. Experience leading NCQA Accreditation initiatives. Experience leading or supporting NCQA Health Equity Accreditation. Experience within an integrated delivery network, ACO, or payvider model. Experience partnering with providers to improve quality and clinical outcomes. Education: Masters Degree (Required) Certifications: Certified Professional-Healthcare Quality - National Association for Healthcare Quality, Lean Six Sigma Black Belt - LEAN Compensation Note: The compensation range(s) in the table below represent the base salaries for all positions at a given grade across the health system. Typically, a new hire can expect a starting salary somewhere in the lower part of the range. Actual salaries may vary by position and will be determined based on the candidate's relevant experience. No employee will be paid below the minimum of the range. Pay ranges are listed as hourly for non-exempt employees and based on assumed full time commitment for exempt employees. Minimum - Midpoint - Maximum $158,371.00 - $182,041.00 - $215,342.00 Equal Employment Opportunity Employer Baystate Health is an Equal Opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, marital status, national origin, ancestry, age, genetic information, disability, or protected veteran status.