Quality Management Analytics Manager - Hybrid NYC

Job Description

Job Description

MUST HAVE MANAGED CARE EXPERIENCE WITHIN NYS HEALTHCARE PROVIDER NETWORKS

Our company provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc.

As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, and includes over 27,000 primary care providers, specialists and participating clinics.

For more than 30 years. Wehave been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.

Position Overview

The Quality Management (QM) Analytics Manager will be responsible for supervision of the QM Analytics Team, which includes four Analysts.

The team independently maintains the HEDIS / QARR data repository that informs reporting of HEDIS, QARR, and PCMH data to NYS DOH and CMS.

To that end, the team carries the responsibility of ensuring the monthly rates and annual HEDIS and QARR submissions are timely, and quality checked for accuracy and completion.

This includes managing the end-to-end process of integrating

claims, provider, member, encounter, and supplemental data into quality measure rates. To successfully perform these duties, the QM Analytics Manager collaborates with all levels of the organization including our largest provider, NYC Health + Hospitals and works closely with appropriate vendors.

The vendors include, but are not limited to : HEDIS software vendor, member rewards vendor, communications vendor, and provider and member portal vendor, as well as the CMS and NY state-mandated vendors for data transmission.

The QM Analytics Manager also retains responsibility for the development of program forecasting models and actual and predictive quality program dashboards to ensure provider pay for performance program budgets and QM / Plan quality goals are identified, tracked, and met.

The role will also mentor and train analytics staff on all applications and processes and develop strategic plans to ensure deadlines are met, while still maintaining data integrity.

Additionally, this position guides and works with Quality Improvement Specialists to ensure data requests are aligned with project needs, interpretation of data is correctly interpreted & reported.

The position may also be responsible for duties tied to the development of new programs and initiatives as assigned by the Director of QM Analytics.

Job Description

• Responsible for developing and maintaining processes to implement, test, and validate supplemental data collected from providers
• Communicate, as needed, with the NYS or Departments of Health on relevant analyses.
• Provides technical mentorship to QM Provider Engagement, Quality Review Leads and Quality Improvement Specialists
• Functions as mid-level escalation support for all applications; Escalate data issues needing process re-engineering.
• Selects, develops, manages, and evaluates direct reports.
• Mentors the data team in leading system implementation (i.e., new modules,upgrades, product installs).
• Communicates clear instructions to project team members. Coaches and
• mentors team members and monitors team member performance and key project benchmarks.

Relationship Management

Supports productive inter / intra departmental and vendor work relationships. Specifically, HEDIS vendor relationships, including HEDIS software vendor and Health Exchange Registries.

Manages vendor relationships to ensure deadlines and deliverable are met.

• Interfaces with key IT, clinical, business and operations staff to develop efficient workflows.
• Analyzes business operations as they relate to decisions and proposes improvements where possible.
• Retain subject-matter-expert knowledge of MetroPlus programs and HEDIS / QARR / QRS specifications.
• Ensure MetroPlus is in compliance with government and agency regulations as they relate to NYS DOH, CMS, NCQA standards for required data submissions.

Reporting & Analytics

• Responsible for providing quality initiative analytics for Quality Management. Supports provider and member interventions impacting quality with ongoing and ad hoc reports.
• Supervision of the QM Analytics team. Guides and mentors, the team in utilizing new and existing functionality for projects by ensuring deployment with a focus on timeliness, efficiency and consistency across analysts.
• Ensures the development, maintenance and timely distribution of Provider Pay for Performance Program forecasting models, quality program dashboards, measure data profiles, and gap in care reports.
• Establishes reporting and analytics strategies and ensures they are integrated into scope and delivery of projects in accordance with IT project standards and best practices.
• Promotes effective and efficient use and delivery of reporting and analytics tools to meet business needs and support key quality improvement activities.
• Responsible for the integration of new data as well as the maintenance of existing data sources included in HEDIS and QARR reporting.
• Manages and delivers tracking solutions for Clinical Quality Reporting Projects. Responsible for coordination of development, testing, QA, and implementation of new functionality.
• Assist in preparation of data reports, training materials, business presentations, publications, marketing collaterals, and other educational materials.

Trains staff as necessary.

Other duties as assigned by Director of QM Analytics.

Requirements

Minimum Qualifications

• Bachelor’s degree in public health, health administration, business administration or information technology required. Master’s degree preferred.
• A minimum of 5 years’ programming, application or reporting development experience and analytical experience (SAS, SQL, Crystal Reports, etc.).
• Experience using analytics / BI packages (e.g., SAS, R, SQL, Cognos, Business Objects) to build client analysis solutions.
• Must have advanced working knowledge of Microsoft Office applications including Word, Excel, PowerPoint, Visio, and Access.
• Position requires individual with high degree of accuracy. Must be able to translate theoretical knowledge into practical application.
27 days ago