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Clinical Reporting, Professional, Quality Initiatives Lead

Headquarters Office, 625 State Street, Schenectady, New York, United States of America; Rochester Office, 220 Alexander Street, Rochester, New York, United States of America; Tarrytown Office, 303 South Broadway, Tarrytown, New York, United States of America Req #213
Friday, November 22, 2019
Be a part of the transformation at MVP Health Care®. MVP Health Care is a nationally-recognized, regional not-for-profit health insurer. We care for more than 700,000 members across New York and Vermont and are powered by the ideas and energy of more than 1,700 employees. We employ talented people  with diverse backgrounds and experience—tech people, numbers people, even people people—to make health insurance more convenient, more supportive, and more personal. If you’re ready to join a thriving, mission-driven company where you can create your own opportunities—it’s time to make a healthy career move to MVP.

Status: Full-time, Exempt: Yes


Obtain and analyze monthly data required for NCQA standards, HEDIS/QARR measures and CMS Star quality ratings. Interpret these findings, identify barriers, and
propose methods for improvement. Develop documentation and reporting tools to
allow QI to track the progress and success of our outreach and interventions at both the member and provider level. Perform as an active member of all quality meetings that pertain to increasing quality results for members with both physical and behavioral health conditions. Assist in the development of BH strategy for outreach to providers and members.

  • Develop BH Provider Incentive programs and collateral, such as Medicaid RQI and Marketplace Incentive.
  • Coordinates the distribution of Quality data to our BH provider community, working collaboratively with Provider relations, Provider Engagement and Networks.

  • Develops and implements a system of communications and tracking that ensures all physicians and practitioners have access to reports.

  • Influences provider practice patterns in a positive manner for all lines of business to improve the quality of care and encourage appropriate care to be delivered in the appropriate setting.

  • Develop Member Incentive programs and collateral, obtain NYS approval when necessary.

  • Coordinate member call campaigns, mailings and incentive programs to support QI outreach and interventions.
  • Work collaboratively with internal MVP partners to develop opportunities for member and provider education and improving the health of our member community.

Performs other duties as assigned by management.

 

POSITION QUALIFICATIONS

Minimum Education:

Bachelor's degree or equivalent combination of education and experience in a managed care environment.


Minimum Experience:

Minimum of three years health care or managed care experience is required.

Experience in quality improvement for mental health and Substance Use Disorders (SUD) service programs, ideally in publicly operated or publicly funded programs. 


Required Skills:

  • Knowledge of family-centered, youth-guided service delivery for children and families with BH needs.
  • Knowledge of appropriate BH performance measures (including HEDIS and QARR) for children and adults.

  • Excellent analytical skills are required. Takes action to solve problems and move situations to closure while demonstrating sound judgment and a clear understanding of issues. 

  • Demonstrated experience with and proficiency in the management of data, reports and database. 

  • Superior attention to detail and strong project management skills are required.
    Prioritizes various competing tasks and performs them efficiently according to their urgency. 

  • Adapts and works effectively with individuals or groups. Works comfortably during changing circumstances. Adapts approach as the requirements of a situation change. Changes or easily accepts changes in job requirements.

  • Excellent interpersonal and communication (telephone, verbal and written) skills
    required.

  • High proficiency with Microsoft Office Suite.
  • Some travel including periodic overnight stays will be required

 

Preferred Skills:

• Experience with Macess, Facets and/or Care Radius is a plus.



MVP Health Care is an Affirmative Action/Equal Opportunity Employer (PDF). We recruit, employ, train, compensate, and promote without regard to race, religion, creed, color, national origin, age, gender, sexual orientation, marital status, disability, genetic information, veteran status, or any other basis, e.g., Pay Transparency (PDF), protected by applicable federal, state or local law. Any person with a disability needing special accommodations to the application process, please contact Human Resources at hr@mvphealthcare.com.

Other details

  • Job Family Medical Management/Clinical
  • Pay Type Salary
  • Headquarters Office, 625 State Street, Schenectady, New York, United States of America
  • Rochester Office, 220 Alexander Street, Rochester, New York, United States of America
  • Tarrytown Office, 303 South Broadway, Tarrytown, New York, United States of America