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.
Provider Engagement Quality Associate - Hybrid
Summary of Job
Build relationships with external providers and vendors to create shared understanding of organizational quality goals. Identify, develop, execute and evaluate quality and process improvement projects in partnership with providers and/or vendors that support public health, HEDIS®, QARR, NCQA and other regulatory needs. Utilize tools to monitor and drive improvement in key quality Medicare STARS and Medicaid incentive measures with provider groups. Collaborate with colleagues in Provider Network and Product, Analysts, IT, Marketing and build cross functional teams to align strategies and priorities to achieve quality goals. Partner with department leadership to build upon and grow enterprise-wide provider quality improvement strategy. Ensure that gains are maintained by providers, and corrective actions are taken as necessary to ensure performance improvement and to support compliance with regulatory and accreditation bodies.
Responsibilities
• Maintain key relationships with providers, office staff and other external stakeholders.
• Establish consistent communication and collaboration structure with assigned provider groups.
• Build relationships with internal stakeholders (e.g. provider network, marketing) and create cross-functional teams to create a more streamlined experience for the provider.
• Create and align shared understanding of quality goals.
• Implement processes for two-way data sharing and work with quality data team to develop structure.
• Review performance dashboards, highlight opportunities and translate findings into actionable interventions.
• Monitor and track quality performance against provider contracts; make recommendations to contracts to ensure goal alignment.
• Prepare reports, presentations and executive level summaries to share projects, processes, results and highlight collaboration efforts.
• Create action plans and workplans to achieve performance improvement in HEDIS and CAHPS results.
• Create engagement and quality educational tools which providers can utilize in their office.
• Improve the understanding of quality measures through the use of educational programs (e.g. lunch and learns, webinars) and increase satisfaction and improved gap in care outcomes.
• Share and roll-out provider incentive programs.
• Ensure compliance with regulatory bodies and accreditation; implement corrective action and performance improvement projects as needed.
• Recommend best practices and evidence-based guidelines for care integration, preventive care, care coordination and patient experience.
Qualifications
• Bachelor’s Degree in a health services field (Required)
• Master’s degree in public health, public administration, social work, health services (Preferred)
• 3 – 5+ years’ experience in a health care related field, preferably managed care (Required)
• Quality improvement experience in a managed care environment (Preferred)
• Proficient in Microsoft Office - Word, Excel, PowerPoint, Outlook, Teams, SharePoint, etc. (Required)
• Ability to develop cross-functional teams and work collaboratively with different levels of staff (Required)
• Familiar with and have a working knowledge with QI process improvement methodology strategies, e.g. PDSA (Required)
• Possess understanding of quality measures including HEDIS®, QARR, CAHPS (Required)
• Superior planning and organizational skills to collect, organize and present information clearly (Required)
• Ability to assess all work and prioritize as necessary to meet reporting timeframes and deadlines (Required)
• Independent thinker; strong critical thinking and problem-solving skills (Required)
• Ability to travel to provider accounts and work with team members in several locations where the company has offices (Required)
• Experience with and proficient in reviewing and summarizing data into actionable and simple reports and presentations (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.