Job Ref: 126812
Category: Professional
Department: QUALITY MANAGEMENT
Location: 50 Water Street, 7th Floor, New York, NY 10004
Job Type: Regular
Employment Type: Full-Time
Hire In Rate: $180,000.00
Salary Range: $180,000.00 - $200,000.00

POSITION OVERVIEW

The Senior Director of Quality Performance Improvement will participate in developing the vision and strategic direction for the Quality Management department. This position will work with the VP of Quality Management to design and execute the organization’s quality improvement (QI) workplan and serve as a subject matter expert for HEDIS/QARR, CAHPS and HOS metrics, the NYS Department of Health (DOH) Quality Incentive Awards and CMS Star Ratings Program. The Senior Director has direction of a cross-functional team of clinical and non-clinical staff responsible for improving quality performance in preventive care, chronic care, behavioral health and member experience in all lines of business. This position will be the primary driver of the Plan’s quality-based provider engagement strategy and provide clinical oversight of quality improvement interventions for members and providers.
The Senior Director of Quality Performance Improvement is also responsible for oversight of timely and satisfactory completion of regulatory projects and programs such as the Department of Health (DOH) Performance Improvement Projects (PIP) & Quality Matrix, the Medicare & UltraCare Chronic Care Improvement Project (CCIP) and support of the Medicare & UltraCare Model of Care (MOC). Participation in product line related audits pertaining to clinical and operational quality metrics are also under the purview of this role, such as Article 44 and Special Needs Plan
Model of Care audits.

MINIMUM QUALIFICATIONS

• Master’s degree in public health, health administration, and/or clinical field.
• 10+ years’ experience in healthcare or managed care industry. 5+ years’ experience in a clinical setting is a plus.
• Strong analytical/quantitative skills. Background in statistics and/or data analysis is a plus.
• Extensive experience and knowledge with HEDIS/QARR/CAHPS/HOS, CMS Star Ratings.
• Proficiency in Microsoft Office (Word, PowerPoint, Excel, Access).
• Clinical license (MD, NP, RN, PharmD, LMSW/LCSW etc.) with 5+ years clinical experience preferred.

• Participate in the development of the vision and strategic direction for Quality Management; works with the VP of Quality Management in the design and execution of the organization’s quality improvement (QI) workplan and serves as a HEDIS/QARR/STARS, CAHPS and HOS subject matter expert.
• Manage and lead cross-functional team to develop strategies, implement action plans, and oversee ongoing operational executions to meet corporate business goals for healthcare quality performance and cost containment.
• Drive the Plan’s quality-based provider engagement strategy to close gaps-in-care and improve risk scores. Collaborate with network providers to ensure quality improvement projects are clinically sound, care is consistent with HEDIS/QARR requirements (including coding practices) and auxiliary data streams are established, if needed.
• With the CAHPS Director, design and execute an organization-wide, line-of-business specific quality improvement (QI) strategy for CAHPS metrics. Drives MetroPlusHealth’s goal to provide top-tier experience to members through data-driven improvement activities and interdepartmental collaboration.
• Assists in the identification and alignment of quality measures selected for the MetroPlus Member Rewards Program, Provider Pay for Performance Program and Value-Based Programs with the regulatory quality incentive programs driving towards incentive maximization and continued improvement in member health outcomes.
• Leads the QI team’s efforts to identify improvement areas, understand marketplace and member/provider behaviors, research member/provider barriers and validate them within the population, develop predictive models, perform root-cause analysis, and evaluate program effectiveness for quality performance metrics. Synthesizes multiple data streams for clinical and CAHPS metrics to identify high-risk members.
• Identify process improvement opportunities and provide guidance and direct oversight to automate processes, implement efficiencies, or execute needed changes.
• Maintain up-to- date knowledge and understanding of HEDIS/QARR/CAHPS measure technical specifications and CMS Star Rating measures, including HOS & Operational measures.
• Responsible for regulatory oversight of DOH Performance Improvement Projects and Matrices, the Medicare & UltraCare Chronic Care Improvement Project (CCIP) and the Medicare & UltraCare Model of Care (MOC), as well as any product line-related audits pertaining to clinical and operational quality metrics.
• Convene and lead work groups with external vendors and internal staff in support of quality measure improvement.
• Oversee evaluation of the effectiveness of interventions, dashboards, and operational performance indicators to better assess the organization’s ability to meet quality targets. Track and report on initiative progress at all appropriate levels of the organization, including Quality Management Committee and Quality Assurance and Performance Improvement Committee.