Clinical Reporting, Professional, Quality Initiatives Lead
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.
Bachelor's degree or equivalent combination of education and experience in a managed care environment.
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.
- 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
- High proficiency with Microsoft Office Suite.
Some travel including periodic overnight stays will be required
• Experience with Macess, Facets and/or Care Radius is a plus.
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- 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