Manager, Quality Improvement - Remote

STARS & QUALITY

Implement, track, and report on performance improvement initiatives, on measures that directly impact EmblemHealth's rankings on the quality rating programs. Collaborate with the leadership of Provider Network and Product, Analysts, Member facing departments, IT and other cross functional teams to align strategies and quality improvement priorities in contracting, vendor relationships, sales and product development, and procurement. Identify improvement opportunities and provide guidance for needed changes. Manage the provider quality strategy, including implementation of key initiatives. Develop, manage, and report on various quality provider facing programs including the Provider P4P Program (QIP), various VBP arrangements. Manage and monitor Quality Improvement metrics in collaboration with department leadership to ensure that gains are maintained, and corrective actions are taken as necessary to ensure performance improvement and to support compliance with HEDIS, QARR, and Star processes across all regions where we have membership.

Responsibilities

• Responsible for managing the Quality Execution Team, to drive identification and execution of initiatives to increase EmblemHealth's quality ratings (Medicare Stars, Quality Incentive Awards, Quality Rankings, Accreditation Status) and ensure compliance with NCQA, state and federal regulations and requirements.
• Implement the Member Rewards Programs.
• Track, monitoring and analyzing initiative key performance indicators and performance on various quality measures i.e. HEDIS / QARR, including analysis of trends in performance against national and regional benchmarks.
• Partner with internal departments, external vendors and medical groups to improve or maintain healthcare quality metrics and outcomes.
• Develop and manage Quality education materials and tools for providers and vendors.
• Educate company teams on the importance of measures for improving quality ratings and understand their current strategies and plans to improve performance on those measures.
• Manage the Provider Incentive Program (QIP) across the enterprise to drive improved quality performance of network providers.
• Support various VBP contracts by owning the quality and member satisfaction sections.
• Manage various quality collaborative efforts / initiatives with key provider groups.
• Manage relationship with provider engagement team and attend JOCs representing quality.
• Lead selected quality improvement committees, subcommittees and workgroups to support process improvement activities. Review and update operational processes relating to quality management activities. Define and document newly established processes.
• Support preparation, organization and follow-up in acquiring and maintaining NCQA accreditation and compliance with local, state and federal regulatory authorities, includes support of the health plan's HEDIS, QARR, and Star processes.

Qualifications

Requisition ID : 1000002652

Hiring Range : $77,760-$149,040