Virginia Premier Health Plan, Inc.

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Director, Quality - Dual Eligible Program and MLTSS

Director, Quality - Dual Eligible Program and MLTSS

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Job Description


The responsibility of the Director of Quality is the oversight and management of Medicare Quality and Medicaid Long Term Services and Supports (MLTSS) to meet the requirements of Medicare Advantage (Part C), HEDIS, HOS, CAHPS, behavioral health measures, care coordination/transition measures and LTSS as outlined in the Virginia MOU and three-way contract. The core functions/services included are: quality of care issues, sentinel events, quality related regulatory and accreditation audits and other quality related activities for Medicare.


  • Oversight and management of the Dual Eligible and MLTSS Quality Department.
  • Develops departmental goals that enhance the functionality of the department and the company
  • Develop and implements the Health Plan’s Medicare Quality Program with yearly evaluations reportable to the Health Quality and Utilization Committee, Continuous Quality Improvement Committee, and Medicare regulatory committees.
  • Analyze organizational processes, policies, procedures and standard operating procedures to meet accreditation guidelines.
  • Utilizes, integrates, and interprets data to assist VPHP in its improvement efforts, and promotes optimal patient outcomes.
  • Leads organizational Duals and MLTSS performance efforts for NCQA, Medicare Advantage (Part C), HOS, CAHPS, core quality measures, performance improvement projects and all other accrediting and regulatory requirements outlined in the Virginia MOU, three way contact and participates in all regulatory site reviews for Medicare.
  • Works with the AVP, Medicaid & Duals Health Services to ensure all quality and accreditation goals are met for the company.
  • Ensures quality compliance with regulatory and accrediting agency requirements
  • Develops and implements educational programs for employees, participating practitioners/providers and members on Duals and MLTSS’ Quality.
  • Participates in and provides leadership for organizational patient safety initiatives
  • Development and implementation of a plan for on-going monitoring and enhancement of procedures and policies.
  • Conducts active problem identification and resolution to improve overall department efficiency and quality outcomes.
  • Educates company on new and existing accreditation and regulatory requirements and conducts audits to ensure fulfilling accreditation requirements.
  • Uses effective communication with various internal departments and external customers to accomplish goals of the department



  • 5 years of progressive management experience in the area of Quality
  • Bachelor's degree. Masters highly preferred


  • Proven leadership skills
  • Ability to organize, prioritize tasks and develop systems to meet objectives of the department, company, and business associates.
  • Experience with Medicare Advantage quality measures
  • Strong organizational, analytical and interpersonal skills
  • Managed care experience required



  • Three years of experience and knowledge in managed care, preferably Medicare Advantage
  • Highly motivated individual with the ability to work independently
  • Must possess strong leadership capability, problem-solving and organizational skills, and the desire to foster good working rapport
  • Previous management experience with two years management in the MCO setting



Physical health sufficient to meet the ergonomic standards and demands of the position.



We offer competitive salaries and a comprehensive benefits package to include excellent Medical, Dental and Vision Plans, Tuition Assistance, Infant-At-Work Program, Remote Work options and generous vacation and sick leave policies. Our culture supports an environment where employees can continuously learn and gain professional growth through various development programs, education, exciting projects and career mobility.  


Our mission is to inspire healthy living within the communities we serve!


About Us

Virginia Premier Health Plan, Inc. is a managed care organization which began as a full-service Medicaid MCO in 1995. Partnered with VCU Medical Systems we strive to meet the needs of the underserved and vulnerable populations in Virginia by delivering quality driven, culturally sensitive and financially viable Medicare and Medicaid healthcare programs. Headquartered in Richmond, VA we also have offices in Roanoke, Tidewater and Bristol with additional satellite locations allowing us to serve over 200,000 members across eighty counties throughout Virginia. 


Equal Opportunity Employer All qualified applicants will receive consideration for employment without regard to age, race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.


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