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Quality Improvement Director

Date:  Mar 9, 2023

Any city, OH, US, 99999

Req ID:  16967


The PBM Quality Improvement Manager is responsible for continuous improvement to Gainwell PBM services in Ohio.

They must define, implement, and evaluate data-driven strategies to achieve high quality outcomes for populations served by the

Ohio Department of Medicaid (ODM) Single Pharmacy Benefits Manager (SPBM).

His or her team will support Ohio in applying quality improvement science throughout the organization.

This person will lead a team who will oversee day-to-day quality improvement operations.


Your role in our mission

•    Facilitates identification, design, implementation, and evaluation of quality improvement initiatives

•    Develops and maintains the SPBM’s quality improvement strategies and tactics

•    Champions and articulates the value of the SPBM’s quality improvement model to leadership and key stakeholders

•    Works to embed quality improvement standards across the organization so that quality improvement becomes part of the practices and processes

•    Ensures alignment of SPBM quality improvement activities with ODM’s quality strategy

•    Manages the analysis of pharmacy data against identified quality standards to ensure performance and identify opportunities for improved performance.

•    Develops and maintains stakeholder relationships; analyzes customer concerns and issues and addresses issues appropriately and promptly.

•    Selects, hires and manages employees.

•    Prepares and recommends operating and personnel budgets for approval. Monitors spending for adherence to budget, recommends variances as necessary.

What we're looking for

•    Bachelor's degree in health-related field or equivalent combination of education and experience

•    Three or more years of experience in quality improvement within managed care or PBM pharmacy operations

•    Five or more years of leadership or supervisory experience

•    Experience working with pharmacy claims, care coordination and pharmacy financial processes

•    Experience working with quality improvement methodologies in pharmacy (ex. Lean, Six-Sigma, IHI’s Model for Improvement)

•    Demonstrated knowledge of health equity and its evaluation is required

•    Experience evaluating and benchmarking healthcare quality metrics

•    Experience in data collection, data interpretation, evaluating intervention outcomes, identifying issues within a population, and evaluating social determinants of health

What you should expect in this role

•    Work from Home; reliable high-speed internet connectivity is required

•    Employees working-from-home may be asked to report to the office, at times, to support work efforts.

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