Provide medical leadership in quality improvement activities in commercial lines of business programs. Participates with HMSA’s quality management team to improve the quality of care provided to HMSA’s commercial members; mentors a given physician or group of physicians in the principles and execution of quality improvement interventions; supports transfer of knowledge about National Committee for Quality Assurance (NCQA) measures, scoring methods, and clinical objectives.
Meets with specialty physician groups to define and understand relevant evidence based clinical metrics. Participates in specialty physician clinical metrics development and reporting as a part of Pay-for-Quality program development for specialty providers.
Duties and Responsibilities:
Provides clinical leadership in physician relationship building for purposes of quality improvement and cost of care improvement initiatives.
Maintains subject matter expertise in quality improvement measures, and scoring methodology for N.C.Q.A. accreditation.
Participates with provider engagement of academic detailing within the provider community.
Participates in the development, technical aspects, and clinical scoring of the Pay-for-Performance programs in the commercial lines of business. Educates network providers to the clinical and financial opportunities in HMSA’s Pay for Quality and Shared Savings Programs.
Assist in Clinical Practice Guideline development and Review.
f. Oversee Quality of Care Complaint Resolution with Quality Improvement Staff.
Perform other duties as assigned.
MD/DO degree with current Board Certification.
Five years clinical experience.
Demonstrated leadership skills and collaborative leadership style.
Expertise in quality, disease management and evidence-based medicine.
Excellent relationship and facilitation skills.
Strong organizational skills.
Decisive and action oriented.
Strong verbal and written communication skills.
Hawaii Medical Service Association - 17 months ago
Hawaii Medical Service Association (HMSA) is Hawaii's largest health insurance company. The not-for-profit company serves more than...