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.
Quality Programs Manager - Hybrid
Summary of Job
Oversee and actively participate in quality improvement projects. Contribute to the overall success of Quality Programs by promoting /advancing the department mission of effectively managing members and improving health outcomes. Serve as the Quality Management liaison for internal and external partners for projects and improvement initiatives. Subject matter knowledge expert with regards to quality improvement & reporting.
Responsibilities
• Work directly with business partners to plan, implement, and oversee ongoing operational execution of quality improvement projects and action plans (HEDIS, CAPHS, and HOS) to meet corporate business goals for Medicare, Medicaid, QHP, and Commercial product lines.
• Support the execution of centrally developed and data-driven strategic plans.
• Assist in leading cross-functional teams for collaboration on HEDIS, CAHPS, HOS, Pharmacy, and Enterprise metrics.
• Serve as a point of contact for quality vendors: develop and share target lists; provide support in monitoring performance against established Service Level Agreements; provide a communication bridge between the company/line(s) of business and the vendors.
• Manage ongoing quality programs including Member Rewards & Incentives, Provider Quality Incentives, and addressing Health Disparity initiatives.
• Provide subject matter expertise and support on all quality metrics to key stakeholders.
• Support NCQA/CMS/HEDIS/CAHPS/HOS and other regulatory requirements that apply to quality programs.
• Work with the data team to conduct analysis and reporting as needed on initiatives designed to impact quality performance to provide insight to future projects.
• Develop annual performance improvement projects; analyze project data; and ensure completion of the finished product(s) including the development of year-end report(s).
• Develop methodologies for quality program assessment (ROI and proof points of program outcomes, etc.)
Qualifications
• Bachelor’s Degree; Master’s Degree (Strongly Preferred)
• Project Management/Vendor Management certification (Preferred)
• 5 – 8 years of relevant, professional work experience (Required)
• 3 – 5 years of Quality and/or program management experience in a managed care organization (Required)
• Additional years of experience/specialized training/certifications may be considered in lieu of educational requirements (Required)
• Experience in researching, developing, implementing, and assessing results of metrics and analytics (Required)
• Understanding of contractual or compliance related SLAs (Required)
• Ability to successfully manage multiple projects/tasks with competing priority levels and deadlines (Required)
• Experience and knowledge with HEDIS/QARR, CAHPS, CMS Star Ratings, and Accreditation (Required)
• Proficient in MS Office - Word, PowerPoint, Excel, Outlook (Required)
• Excellent communication skills - verbal, written, presentation, interpersonal, active listening (Required)
• Working knowledge of MS Access (Preferred)
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.