CHESS: Quality Programs Manager

Quality Programs Manager Position Summary : The Quality Programs Manager provides leadership for quality program services to support value-based care throughout the CHESS network.

The Manager uses skills to coordinate and provide quality program services to CHESS value partners to ensure they maintain or achieve high quality performance across value-based contracts, lead and develop a quality team, improve processes, and provide outstanding service to internal and external customers. Position Responsibilities :

• Serve as a quality programs expert for internal and external customers and assist customers in defining problems and needs related to education, data, reporting, analytics, and performance
• Maintain knowledge of latest information available from NCQA, CMS, payer resources, and other quality references
• Coordinate quality activities for efficiency and effectiveness
• Supervise quality team, ensuring high quality work product and encouraging innovation and engagement
• Provide consultation to team members, including advising on time management and other professional skills
• Identify growth needs for department, develop, and execute plans for individual and group professional development
• Coordinate recruitment, hiring, and new-hire onboarding of new personnel with the Director
• Build strong relationships with internal and external customers
• Evaluate, develop, and implement strategies to improve customer satisfaction
• Engage internal and external customers in new development and process improvements in quality programs for excellence in client deliverables
• With the leadership team, assists with the development, revision, implementation and communication of strategic initiatives and goals
• Support the development of quality program standards
• Maintain a quality programs roadmap
• Partner with other departments to assure successful implementation of new value partners, new contracts, and new quality measures
• Standardize and document processes and approaches to quality measurement, monitoring, and reporting for the team
• Validate accuracy of quality data elements in payer reporting and internal analytics tools
• Assist in accurate data entry into quality data analytics / aggregation tools for quality monitoring, reporting or other program requirements
• Interpret quality related information from various electronic medical record (EMR) templates. Oversee continuous quality data monitoring to ensure accurate capture from client EHRs.
• Utilize dashboards and reports as visualizations to guide quality performance. Review, analyze and disseminate quality performance information from multiple internal and external quality reports.
• Perform analysis and assists internal and external customers to identify trends and shifts in quality performance.
• Assess the progression of quality performance to goals. Understand and interpret quality measure results and be able to recommend performance strategies from best practices, care models, and evidence-based guidelines.
• Prepare ad hoc reporting and analysis of quality data as needed
• Participate in quality reporting processes across payers, including dispute resolution
• Evaluate information and needs of internal and external customers in support of quality objectives
• Support and assist with design of quality programs and procedures as needed
• Prepare content and present quality education to various internal and external stakeholder audiences
• Manage, maintain, and update a library of quality program references, resources, measure specifications, and other relevant information
• Ensure requests for information are handled promptly, in compliance with policies, and effectively

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job.

Duties, responsibilities, and activities may change at any time with or without notice. Position Qualifications :

Required

• Bachelor’s degree in Health or Business Administration, Analytics, or related area
• 5 years’ experience in ambulatory healthcare quality programs
• Experience in data abstraction, entry, and / or analysis
• Experience with electronic medical record systems
• Proven ability to manage multiple projects simultaneously
• Proven ability to multi-task and remain focused in a fast-paced environment

Preferred

• Master’s degree in Health or Business Administration, Analytics, or related area
• Clinical Healthcare background

Skills, Knowledge, and Abilities :

• Solid understanding of quality measures in various value-based contracts, such as CMS ACO models, Medicare Advantage, and Commercial quality programs
• Experience with cross-team collaboration for troubleshooting and solving complex problems and process issues. Effective problem-solving and influencing skills.
• Excellent written and verbal communication skills, including ability to present topics to and adapt content for various audiences
• Experience with accountable care organizations and value-based care quality programs
• Experience leading a team
• Lean Six Sigma and continuous improvement methodology
• Knowledge of computer systems, programs, and spreadsheet applications
• Proficiency in using Microsoft programs (Word, Excel, PowerPoint)
• Knowledge of medical terminology
• Exceptional customer service, and interpersonal skills
• Strong organization skills
• Ability to work independently and collaboratively. Ability to act with autonomy and be flexible as team and client needs change.

Key Competencies :

• Service orientation
• Integrity
• Ethical practice and confidentiality

MedCost provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.

MedCost participates in the Electronic Verification system (E-Verify) to electronically verify the work authorization of newly-hired employees.

E-Verify is an internet-based program that compares information from an employee's Form I-9 to data contained in the federal records of the Social Security Administration and the Department of Homeland Security to confirm employment eligibility.

MedCost does not use E-Verify to pre-screen job applicants.