Manager of Quality Performance Improvement in New York, NY

  • Title: Manager of Quality Performance Improvement
  • Code: RCI-81351
  • Location: New York, NY 10004
  • Posted Date: 11/14/2022
  • Duration:
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  Job Description

Position Overview

  • The Manager of Quality Management’s primary function is to plan, develop, manage and evaluate clinical quality and process improvement projects required to support public health, HEDIS, QARR and other regulatory and accreditation quality projects.
  • This position provides the leadership necessary to achieve national best practice performance levels in quality improvement.
  • This position executes various evaluations of QI interventions/programs that drives continuous knowledge building and improvement in how Client will target and address our membership so that performance is significantly improved as measured by HEDIS and QARR.

Job Description

  • Oversees Quality Improvement Specialists in the design, implementation and evaluation of quality and process improvement projects required to support public health, HEDIS, QARR, Stars and other regulatory needs to drive quality improvement;
  • Collaborates with other leaders in developing, monitoring, and evaluating improvement actions plans
  • Establishes professional relationships with key stakeholders and community agencies to facilitate quality process internally and externally
  • Coordinates and completes all Quality Improvement activities required to meet regulatory performance initiatives
  • Develops strategies for close coordination of QI related functions with departments whose activities are directly a part of the Quality Improvement Program
  • Actively participates on committees or workgroups such as Medicaid and Stars workgroup
  • Applies analytics to identify and target various populations to drive quality improvement and measurable outcomes
  • Evaluates interventions for project/intervention continuation and or medication to provide for continuous process improvement
  • Develops tools and supports for the physicians, provider groups, etc. relative to measures/desired outcomes for specific diseases to drive quality improvement
  • Document findings for each initiative and presents results to applicable departments and management
  • Monitors and manages Quality and Performance Improvement Project(s) up to and including documenting performance indicators, outcomes measures, process measures, procedures, interventions and reporting to CMS/DOH/IPRO.
  • Analyze member and provider data for assigned healthcare quality measures and/or population to identify trend and target population/area for quality improvement projects. Data sources and tools may include but not to be limited to the following:
  • Statistical significant changes in rates/stratifications;
  • Member and provider information form government and vendor’s reports and datasets and internal databases
  • Active participant with other departments to coordinate and meet CMS, DOH, HEDIS, URAC and other agencies accreditation and regulatory standards. Identify network needs and best practice benchmarks in relation to quality improvement initiatives
  • Develop and maintain positive business relationships with community organizations, pharmaceutical companies, regulatory agencies and others to promote Client’s involvement with health status improvement within the community and to facilitate excellent customer service and process improvement
  • Responsible for monitoring and evaluating staff performance
  • All other duties and assigned at the discretion of Quality Management Leadership

Minimum Qualifications

  • Superior oral, written and communication skills. Ability to understand and communicate analytic and clinical data to carried audiences
  • Solid analytical and logical skills paired with strong attention to details
  • Must be a versatile, quick learned, who is open to change and enjoys the challenge of unfamiliar tasks
  • Superior project management and documentation skills
  • Must be action oriented, producing results on projects that require risk taking with minimal planning, while keeping self-control during high activity periods
  • Ability to function well independently and in team setting
  • Must be able to make effective and timely decisions by organizing information in a useful manner and orchestrating multiple activities at once to accomplish the goal
  • Must work effectively with others; fostering open dialogue, accountability and common mindsets with the team
  • Must have integrity, fostering an honest and trust relationship with co-workers and management, never compromising the Plan, other employees or self for personal gain
  • Must seek to continuously improve processes for the benefit of the customer by taking personal responsibility for the resolution of customer services
  • Demonstrate leadership skills with the ability to listen, delegate, motivate and direct others effectively to complete projects and necessary tasks
  • Must be able to resolve conflicts, seeing them as opportunities to make appropriate suggestions, listening to all input and to find the common ground
  • Responsible for monitoring and evaluating staff performance
  • Bachelor’s degree in a health services field required. Advanced degree preferred
  • Must have a minimum of 5 years’ experience in the health care field
  • Quality Improvement experience in a managed care environment preferred
  • Must be proficient in a Microsoft Word, PowerPoint, Excel and Access
  • Demonstrated interpersonal/verbal communication skills
  • Ability to lead and manage others
  • Experience with and proficient in data analysis. Working knowledge of relational database and statistical analysis is a plus
  • Must be familiar with and have a working knowledge of QI process improvement methodology strategies including but not limited to PDSA and DMAIC
  • Must be familiar with HEDIS, QARR requirements
  • Must possess analytical skills in order to collect, organize and present data in clear and concise manner
  • Ability to assess all work and prioritize as necessary to meet reporting timeframes and deadline
  • Ability to effectively present information and respond to questions from families, members and providers
  • Ability to implement process improvements
  • Demonstrated problem solving skills
  • Ability to work in a fast-paced environment with changing priorities
  • Six Sigma Yellow or Green Belt preferred

Professional Comptencies

  • Integrity and Trust
  • Customer Focus
  • Functional/Technical skills
  • Written/Oral Communication


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