MetroPlusHealth provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlusHealth's network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlusHealth has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.Position Overiew:The Director of Quality Management (QM) Analytics will have oversight of QM Analytics, which includes a team of Lead and Senior Analysts. The team independently maintains the QM data repository that informs reporting of HEDIS, QARR, and PCMH data to NYS DOH and CMS. To that end, the team carries the responsibility of ensuring the monthly rates and annual HEDIS and QARR submissions are timely, and quality checked for accuracy and completion. This includes managing the end-to-end process of integrating claims, provider, member, encounter, and supplemental data into quality measure rates. To successfully perform these duties, the Director of QM Analytics collaborates with all levels of the organization including our largest provider, NYC Health + Hospitals, and works closely with appropriate vendors. The vendors include, but are not limited to: HEDIS software vendor, member rewards vendor, communications vendor, provider and member portal vendor, HIE and registry contacts, as well as the CMS and NY state-mandated vendors for data transmission.The Director of QM Analytics also has responsibility for the development of MetroPlusHealth quality program forecasting models, actual and predictive quality program dashboards to ensure provider pay for performance program budgets, and QM/Plan quality goals are identified, tracked, and met. The role will also mentor and train QM Analytics staff on all applications and processes and develop strategic plans to ensure deadlines are met, while still maintaining data integrity. Additionally, this position guides and works with the Senior Manager of QM Operations and Director of Quality Improvement, other Managers, and Quality Improvement Project Specialists to ensure data requests are aligned with project requirements and data is accurately reported. The position may also be responsible for duties tied to the development of new programs and initiatives as assigned by the Vice President of Quality Management.
Job DescriptionOversight
- Responsible for developing and maintaining processes to implement, test, and validate supplemental data collected from providers.
- Communicate, as needed, with the NYS Department of Health on relevant analyses.
- Provide technical mentorship to QM Operations Analysts and technical support to Quality Reviewers and Quality Improvement Specialists.
- Function as mid-level escalation support for all applications. Escalate data issues needing process re-engineering.
- Select, develop, manage, and evaluate direct reports.
- Lead the Data team in system implementation (i.e., new modules, upgrades, product installs).
- Communicate clear instructions to project team members. Coach, mentor, and monitor team member performance and key project benchmarks.
Relationship Management
- Build and maintain productive inter/intra departmental and vendor work relationships, specifically, HEDIS vendor relationships, including HEDIS software vendor and Health Exchange Registries. Manage vendor relationships to ensure deadlines and deliverable are met.
- Interface with key IT, clinical, business, and operations staff to develop efficient workflows. Analyze business operations as they relate to decisions and propose improvements where possible.
- Retain subject-matter-expert knowledge of MetroPlusHealth programs and HEDIS/QARR/QRS specifications.
- Ensure MetroPlusHealth is compliant with government and agency regulations as they relate to NYS DOH, CMS, and NCQA standards for required data submissions.
Reporting & Analytics
- Responsible for quality initiative analytics for Quality Management department. Support provider and member interventions impacting quality with ongoing and ad hoc reports.
- Management of the HEDIS/QARR data team. This includes guidance and monitoring of the team's utilization and deployment of new and existing systems and processes with a focus on timeliness, efficiency, and consistency across analysts.
- Ensure the development, maintenance, and timely distribution of Provider Pay for Performance Program forecasting models, quality program dashboards, measure data profiles, and gap in care reports.
- Establish reporting and analytics strategies and ensure they are integrated into scope and delivery of projects in accordance with IT project standards and best practices. Promote effective and efficient use and delivery of reporting and analytics tools to meet business needs and support key quality improvement activities.
- Responsible for the integration of new data as well as the maintenance of existing data sources included in HEDIS and QARR reporting.
- Manage and deliver tracking solutions for Clinical Quality Reporting Projects. Responsible for coordination of development, testing, QA, and implementation of new functionality.
- Assist in preparation of data reports, training materials, business presentations, publications, marketing collaterals, and other educational materials. Train staff as necessary.
- Other duties as assigned by Vice President of Quality Management.
Minimum Qualifications- Bachelor's degree in public health, health administration, business administration or information technology required. Master's Degree preferred.
- A minimum of 10 years of experience programming and/or using analytics / BI packages (e.g., SAS, R, SQL, Cognos, Business Objects) to build client analysis solutions in a health-care environment or analyzing public health data.
- A minimum 3 years of experience completing HEDIS or QARR submissions, including IDSS and member-level files.
- Must have advanced working knowledge of Microsoft Office applications including Word, Excel, PowerPoint, Visio, and Access.
Professional Competencies
- Integrity & Trust
- Customer Focus
- Functional/Technical Skills
- Strong written and verbal presentation as well as data analysis skills required.
- Ability to work independently and multitask to meet deadlines.
- Position requires individual with high degree of accuracy. Must be able to translate theoretical knowledge into practical application.
- Displays strong communication, interpersonal, and leadership ability across all levels coupled with effective problem solving, conceptual thinking, quantitative and analytical skills.
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