About Fallon Health:
Founded in 1977, Fallon Health is a leading health care services organization that supports the diverse and changing needs of those we serve. In addition to offering innovative health insurance solutions and a variety of Medicaid and Medicare products, we excel in creating unique health care programs and services that provide coordinated, integrated care for seniors and individuals with complex health needs. Fallon has consistently ranked among the nation’s top health plans, and is accredited by the National Committee for Quality Assurance for its HMO, Medicare Advantage and Medicaid products. For more information, visit www.fallonhealth.org.
Provides overall direction to the Quality Services Department with responsibility for HEDIS® submission to NCQA, Medicare and Medicaid clinical quality programs and accreditation. Directs all areas related to quality and compliance with NCQA, Division of Insurance, and Center for Medicare and Medicaid, and federal and state regulations. Provides oversight on behalf of the health plan to all vendors that are delegated with managed care functions to ensure that all downstream entities comply with NCQA and other regulatory requirements related to quality. Interacts with other departmental directors to merge the quality services activities with marketing and sales, care services, credentialing and member relations as well as other senior leaders, directors and managers within the health plan.
Education: Master’s Degree in health administration, public health, nursing or related health preferred
License: Nursing or other related discipline preferred
Experience: Minimum of 3-5 years experience in a leadership role within a health care setting directing quality management and care management programs with an emphasis on measurable outcomes based on application of continuous improvement principles. Must demonstrate a proven track record in achieving measurable healther services improvements and knowledgeable about accreditation requirements and HEDIS® and regulatory