Company Statement
For the last 80 years, EmblemHealth has been taking care of New York’s heart and soul, its people. Today, health care is more complex than ever. That’s why we’re at the forefront of change. We work alongside our customers to offer access to high-quality, affordable care, help navigate the health care experience, and make good health achievable; because everyone deserves to be taken care of. We deliver on our mission every day by living our values with our colleagues, members, clients and partners. It begins with caring and respecting all those we work with. We believe a culture of diversity and inclusion is vital to serve our unique and diverse customers. We seek for continues improvement and innovation and believe being agile and nimble is our advantage. We bring a strong sense of partnership to every relationship – internally and externally. The EmblemHealth family of companies offers competitive health, welfare, and retirement benefits as well as incentive pay plans and more.
Manager, Provider Quality Engagement - Hybrid
Summary of Job
Identify, develop, execute, evaluate and provide oversight of quality and process improvement projects required to support public health, HEDIS®, QARR, NCQA and other regulatory quality measures for our network providers that EmblemHealth members receive across the enterprise. Develop 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. Drive and monitor clinical performance with vendor activities to support continued improvement in the quality data set. Collaborate with the leadership of Provider Network and Product, Analysts, IT and other cross functional teams to align strategies and quality improvement priorities in contracting, vendor relationships, sales and product development, and procurement. Manage a team of associates to achieve optimized quality and stars ratings from internal stakeholders and network providers.
Responsibilities
• Support Quality improvement processes for our network providers across all regions where we have members.
• Collaborate cross-functionally and with all vendors to define quality and process improvement projects that support corporate initiatives and have a reasonable chance of success with measurable and timely results.
• Review and analyze quality-related data to design, develop, monitor, and evaluate clinical and administrative service studies to support quality improvement activities and programs.
• Prepare reports, abstracts, and presentations based on the analysis of process/outcome measures of various behavioral health clinical studies and present formal study findings to various committees/groups within the organization as well as at professional conferences.
• Manage the Provider Incentive Program (PIP) across the enterprise to drive improved quality performance of network providers. Carry out project plans and roadmaps for provider collaboratives that define the path to specific actions resulting in improved quality performance for Medicare, Medicaid and the Exchange business. Performance improvement includes HEDIS, CAHPS and HOS measures that will improve plan Quality scores.
• Define and implement the enterprise strategies to deliver quality excellence, including measurement of each strategy to further refine and improve results.
• Manage engagement and Quality education tools for providers and vendors and report on their use and effectiveness.
• Develop measurement tools for data collection, metrics to assess the effectiveness of process revisions, and control tools for use in monitoring and sustaining project results.
• Ensure that corrective action plans are instituted accordingly across the company. Apply appropriate statistical procedures for the analysis of quantitative and qualitative data and evaluation of clinical and administrative service improvement activities.
• Actively participate in 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
• Bachelor’s Degree in a health services field (Required); Advanced degree (Preferred)
• Six Sigma Green or Black Belt (Preferred)
• 5 – 8+ years’ experience in the health care field, preferably in managed care experience (Required)
• Ability to work with staff in several locations where the company has offices, necessitating site visits (Required)
• Staff/process management experience (Preferred)
• Proficient in MS Office - Word, PowerPoint, Excel, Outlook, Teams, SharePoint, etc. (Required)
• Proficient in MS Access (Preferred)
• Experience with and proficient in data analysis (Required)
• Strong working knowledge of relational database and statistical analyses (Preferred)
• Strong working knowledge of QI process improvement methodology strategies - PDSA and DMAIC (Required)
• Familiarity with the HEDIS®, QARR, CAHPS and HOS requirements (Required)
• Must possess analytical skills to collect, organize and present data in a clear and concise manner (Required)
• Ability to assess all work and prioritize as necessary to meet reporting timeframes and deadlines (Required)
Security Disclosure
If you are offered a job from one of the EmblemHealth family of companies that includes ConnectiCare, AdvantageCare Physicians, and WellSpark, the offer confirmation email will come from “HRTalentAcquisition” with the subject line: “Offer of Employment for (job title)” – Please respond online”.
We never ask you to join a Google Hangout, request you to purchase your own equipment or pay to apply. We do not send email from a third-party email service such as Yahoo or Gmail.
Pay Disclosure
A good faith estimate of the compensation range for individuals hired to work for the EmblemHealth Family of Companies is provided. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate’s work experience, education/training, internal peer equity, and market and business considerations. The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. It is not typical for an individual to be hired at or near the top of the range, as compensation decisions depend on each case’s facts and circumstances. Union roles covered by a collective bargaining agreement will compensate in accordance with the union contract.
EEOC Statement
We are committed to leveraging the diverse backgrounds, perspectives, and experiences of our workforce to create opportunities for our people and our business. We are an equal opportunity/affirmative action employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex/gender, sexual orientation, gender identity or expression, pregnancy or related condition, marital status, national origin, disability, protected veteran status or any other characteristic protected by law.
Sponsorship Statement
Depending on factors such as business unit requirements, the nature of the position, cost and applicable laws and regulations, EmblemHealth may provide work visa sponsorship for certain positions.