26 days old

CAHPS Quality Improvement Manager I/II - 002076

Excellus Health Plan Inc.
Buffalo, NY 14202
  • Job Code
    CAHPS008353
This position evaluates, designs, executes, measures, coordinates, leads/facilitates and monitors process improvements within scope of project and/or team charter with the goal of improving the care and experience for members. The position is accountable for leading improvement efforts and appropriate changes in a process that will create a favorable impact. The position requires the individual work collaboratively in cross-functional teams. The position is responsible for delivering projects and programs to improve the health plan's quality ratings.

Essential Responsibilities/Accountabilities:

Level I:

  • Maintains current knowledge of related criteria to provide interpretation of requirements impacting quality and rating programs.
  • Understands how quality measures (i.e., HEDIS/CAHPS/QRS/QARR/Star/HOS) relate to quality rating programs, other regulatory requirements and scoring criteria.
  • Initiates, drives, and leads high level analysis of processes and outcomes to identify opportunities to improve health plan ratings on a universe of measures and Corporate Quality Action Plan goals and objectives.
  • Innovates new processes to impact results, enhance ratings and assist the organization to meet its Health Care Improvement (HCI) strategic objectives and goals.
  • Plans, directs, and coordinates matrixed team activities to manage and implement quality improvement interventions from implementation to conclusion and evaluates efficacy.
  • Responsible for managing work teams surrounding quality improvement efforts.
  • Plans, schedules, monitors, and reports on activities related to the quality improvement intervention/initiatives. Monitors, reports, and communicates outcomes on the progress of work teams, initiatives interventions using data analytic tools, power point presentations and process improvement tools.
  • Identifies and assembles talent and additional resources throughout the organization to meet intervention needs and requirements.
  • Ensures that team activities and interventions meet timeframe goals.
  • Coaches, mentors and counsels members of intervention team to complete tasks and accomplish outcome/goals.
  • Coordinates outreach to members and/or providers based on needs identified during intervention planning, as needed.
  • Meets with management to review intervention status/progress and invokes appropriate escalation to resolve barriers.
  • Establishes appropriate process and outcome measures to ensure improvement effectiveness of intervention for measuring key project criteria.
  • Acts as change agent implementing quality improvement changes that drive higher quality ratings.
  • Monitors and evaluates quality of performance and product from all work within scope of responsibility.
  • Selects and applies appropriate tools to accurately produce work plans. Works with colleagues to produce/recommend/develop long-term plans.
  • Fosters an environment of continuous improvement. Constantly exploring ways to increase efficiencies and productivity, reducing waste and reducing costs.
  • Maintains knowledge of health insurance industry and Health Plan business, organizational policies, and organizational management structures and uses this knowledge to advise on and justify their current use.
  • Communicates effectively with all levels of management. Directly negotiates with and functions as a liaison to ensure intervention goal is met.
  • Acts professionally at all times and encourages professional standards.
  • Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies' mission and values, adhering to the Corporate Code of Conduct and leading to the Lifetime Way values and beliefs.
  • Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures.
  • Regular and reliable attendance is expected and required.
  • Performs other functions as assigned by management.

Level II (in addition to Level I essential responsibilities/accountabilities):
  • Oversees the implementation of new regulatory and quality program changes.
  • Mentors and trains level I staff and internal stakeholders.
  • Partners with internal stakeholders in the development of processes, policies and/or reporting mechanisms to ensure timely collection and reporting of data and/or status as it relates to initiatives directed to improve quality ratings.
  • Creates and conducts quality improvement/health plan rating training for business partners/change-agents/stakeholders to drive an organization wide focus on improving ratings.
  • Develops advanced presentations and utilizes data visualization techniques to communicate impact of initiatives/programs to multi-level audience across the organization.
  • Oversee and manage multiple high visibility improvement projects that require coordination with various departments to assure continuous communication and matrix collaboration across related stakeholders, drive broad scale sustainable improvement and to ensure regulatory requirements are met.
  • Analyzes health care trends. Uses QI techniques to review studies and identify trends in the data. Develops requirements for higher end analytic studies to support quality improvement.
  • Collaborates with analytic partners to develop dashboards and resources within the analytic toolbox.
  • Provides input into Health Care Quality Improvement Action plan/work plan, aligning work with enterprise priorities, monitoring execution of action plan and reporting of progress and outcomes.
  • Provides input of responses to RFI/RFP's received by the organization
  • Perform delegation oversight of applicable vendors to ensure regulatory requirements and service level agreements are being met. Identify areas of risk, work with vendor/delegate on process improvement/corrective action plans, where indicated, and report results a least annually to appropriate committees.

Minimum Qualifications:

NOTE:

We include multiple levels of classification differentiated by demonstrated knowledge, skills, and the ability to manage increasingly independent and/or complex assignments, broader responsibility, additional decision making, and in some cases, becoming a resource to others. In addition to using this differentiated approach to place new hires, it also provides guideposts for employee development and promotional opportunities.

All Levels:

  • Bachelor's degree and a minimum of three (3) years' progressive experience in process improvement and/or quality work (i.e. Analyst, Project Mgr, quality improvement) required.
    • Nursing degree with a valid NYS RN license or a BH clinician with a bachelor's degree in a BH related field preferred .
    • In lieu of degree, a minimum of 9 years' experience in health insurance field or health care delivery.
  • Expert knowledge of Health Plan Operations and understanding of its operating teams and their functions. A minimum of three (3) years' experience in quality improvement.
  • Must possess strong organizational, planning, and interpersonal skills. Demonstrated ability to work with multiple departments, and establish matrix relationships with all levels of internal staff and management within designated timeframes
  • Knowledge of basic quality measurement concepts and improvement tools/techniques and processes.
  • Strong problem-solving skills.
  • Experience and proven success in using Plan, Do, Study, Act process improvement cycle.
  • Knowledge of health insurance industry, federal and state regulations, accreditation standards, and advancements put forth by quality improvement organizations (including but not limited to NCQA, CMS, The Joint Commission, and NYS DOH) preferred.
  • Demonstrated leadership skills.
  • Highly effective oral and written communicator.
  • Demonstrated skills in quality principles especially root cause analysis and problem solving.

Level II (in addition to Level I minimum qualifications):
  • Master's degree preferred.
  • Six years of related work experience required.
  • Minimum of five years Process Improvement or Quality Measurement/Improvement experience in a clinical setting and/or health insurance environment required.
  • Knowledge of federal, state, and accreditation standards and scoring (e.g. NCQA, CMS, Joint Commission, IHI, URAC, AHRQ, NQF, NYSDOH) required.
  • Must possess a thorough working knowledge of all Health Plan policies and procedures and be able to act as a resource to Health Plan staff on such matters.
  • Must be able to establish liaisons with all levels of internal staff and effectively represent the Company to outside professionals.


Physical Requirements:

  • Ability to work while sitting and/or standing while at a workstation viewing a computer and using a keyboard, mouse and/or phone for three (3) or more hours at a time.
  • Typical office environment including fluorescent lighting.
  • Ability to work in a home office for continuous periods of time for business continuity.
  • Ability to travel across the Health Plan service region for meetings and/or trainings as needed.
  • Ability to lift, carry, push or pull 15 pounds or less.
  • Manual dexterity including fine finger motion required.
  • The ability to hear, understand and speak clearly while using a phone, with or without a headset.

************

The Lifetime Healthcare Companies aims to attract the best talent from diverse socioeconomic, cultural and experiential backgrounds, to diversify our workforce and best reflect the communities we serve.

Our mission is to foster an environment where diversity and inclusion are explicitly recognized as fundamental parts of our organizational culture. We believe that diversity of thought and background drives innovation which enables us to provide leading-edge healthcare insurance and services. With that mission in mind, we recruit the best candidates from all communities, to diversify and strengthen our workforce.

OUR COMPANY CULTURE:

Employees are united by our Lifetime Way Values & Behaviors that include compassion, pride, excellence, innovation and having fun! We aim to be an employer of choice by valuing workforce diversity, innovative thinking, employee development, and by offering competitive compensation and benefits.

In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position.

Equal Opportunity Employer





Posted: 2022-09-09 Expires: 2022-10-08
Sponsored by:
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Sponsored by:
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CAHPS Quality Improvement Manager I/II - 002076

Excellus Health Plan Inc.
Buffalo, NY 14202

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