Vice President, Clinical Quality

Job Description

• Develop and execute the organization's clinical quality strategy, ensuring alignment with organizational goals, regulatory requirements, and value-based care initiatives.
• Develop, monitor, and analyze clinical quality performance indicators (KPIs) to assess the effectiveness of care delivery, provider performance, and member health outcomes.
• Ensure compliance with all applicable healthcare organizations including CMS (Centers for Medicare & Medicaid Services), and accreditation standards (e.g., NCQA, URAC).
• Oversee the preparation and submission of quality and performance data to regulatory bodies and healthcare providers.
• Drive initiatives that align clinical quality with cost-effective care delivery, optimizing the balance between high-quality outcomes and managing healthcare costs.
• Develop value-based care models that incentivize high-quality, efficient care delivery while managing total cost of care.
• Provide regular reports on clinical quality metrics to the senior leadership team and key stakeholders, identifying areas for improvement and outlining actionable recommendations.
• Establish and maintain strong partnerships with healthcare regulatory authorities, physician networks, hospitals, and other clinical entities to ensure high-quality care coordination and value-based outcomes.
• Oversee the design, implementation, and ongoing management of pay-for-quality (PFQ) programs that incentivize providers to deliver high-quality, cost-effective care to members.
• Ensure that pay-for-performance metrics align with organizational goals and regulatory requirements, focusing on improving clinical outcomes and reducing unnecessary costs.
• Collaborate with provider networks to communicate program requirements, set clear performance expectations, and drive improvements in care quality and efficiency.
• Analyze performance data to determine incentives, penalties, and adjustments based on quality scores.
• Lead the auditing process for healthcare providers within the network to ensure compliance with clinical quality standards, coding accuracy, billing practices, and utilization management guidelines
• Oversee the regular auditing of provider claims, clinical documentation, and quality data reporting to ensure adherence to internal policies, payer requirements, and industry regulations.
• Responsible for a result-oriented management and development of people and resources, including provision of a strong leadership presence involving resource allocation, monitoring, reporting, and conducting regular staff meetings
• Promote the recruitment and development of UAE Nationals to contribute to Daman's strategic goals

• Minimum 10 years of clinical experience in the healthcare industry
• Minimum 3 years of health insurance industry related background
• Minimum 5 years of which in a management/supervisory position
• Bachelor's degree in medicine, nursing, healthcare administration (Master's degree preferred).

• Dynamic, self-driven with strong business understanding and background of managed care models and value-based reimbursement
• Strong understanding of health insurance operations, data analysis and performance improvement
• Strategic thinking with strong focus on results and high quality of work
• Very good leadership skills including people management, selection and development skills
• Very good command of written/spoken English
• Very good analytical, planning, forecasting, execution and problem-solving skills
• Very good communication, negotiation, and presentation skills
• Knowledge of regulatory requirements and healthcare compliance.