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.

Vice President, Medicare Stars and Quality Management

🔍 New York, New York

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Vice President
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Jun 09, 2020 Post Date
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200F6 Requisition #
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Responsible for EmblemHealth’s Quality Program (Risk Management, Review Operations, Improvement & Health Promotion, Measurement, Delegation Oversight, and Accreditation).  Provide oversight of project management for sub-committee work effort (Provider Engagement, Member Engagement, or Operational Excellence) and cross-functional collaboration to drive improvements in EmblemHealth Medicare Stars ratings.  Provide leadership over projects designed to drive improvements to EmblemHealth’s Medicare Stars rating: reduce administrative and medical costs; improve core process efficiency, effectiveness and responsiveness; measure and improve business critical operational KPIs/metrics, especially in the areas of customer satisfaction/loyalty/retention. Apply Voice of the Customer and Business data to scope the level of improvement required to impact customer loyalty and bottom-line results.  Lead the development of enterprise-wide quality improvement strategies, including developing programs to improve the quality of care and services provided to members across all product lines.  Direct and oversee enterprise-wide HEDIS/QARR/HOS/CAHPS improvement and reporting and EmblemHealth accreditations via NCQA and URAC, ensuring adherence to accreditation standards.  Oversee EmblemHealth clinical quality risk and quality operations review programs.  Oversee delegation programs, ensuring delegates serve EmblemHealth members while meeting/exceeding service and satisfaction expectations, consistent with the mission and values of EmblemHealth.  Co-chair Emblem Health Quality Improvement Committee, Chairs Health Status Improvement Committee and serves as a member of the Customer Experience Committee and the Privacy and Security Subcommittee providing input and direction in support of EmblemHealth’s operating and process improvement initiatives.  Develop EmblemHealth’s Annual QI Program, Evaluation and Work Plan for approval by the QIC and Quality Committees of the Board.  Provide day to day leadership and direction to all direct reports utilizing the enterprise’s core values. Ensure corporate, departmental and budgetary goals are met by continuous evaluation, development of process improvement activities and adaptation of best practices.

Deliverables:
  • Make significant contributions towards EmblemHealth’s short and long-term business initiatives which include Operating Income, Administrative Expenses, Medicare & Medicaid ratings, and Net Promoter Score performance. [specific metrics and benchmarks to be provided].
  • Identify, hire, & train staff members, developing them into strong leaders and creating high-performing, self-directed teams.  Effectively plan for succession planning ensuring talent pipeline.
  • Act as change agent to drive and effect organizational change ensuring key deliverables are met.
Qualifications:
  • Bachelor’s required; Master’s Degree preferred
  • Minimum 12-15 years of managed care experience
  • Strong background in clinical, financial, technical and operations management and demonstrated proficiency in business management similar in scope
  • Strong knowledge of the clinical practice of medicine, health care delivery systems, utilization methods
  • Strong knowledge and understanding of managed care principles and industry evolution
  • Proven ability to interpret and present information to enable senior management and business stakeholders to make sound decisions

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, 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.

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