Senior Director of Quality Performance Improvement

Senior Director of Quality Performance Improvement

Job Ref : 126812

Category : Professional

Department : QUALITY MANAGEMENT

Location : 50 Water Street, 7th Floor,

New York,

NY 10004

Job Type : Regular

Employment Type : Full-Time

Salary Range : $180,000.00 - $200,000.00

Empower. Unite. Care.

MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day.

About NYC Health + Hospitals

MetroPlus Health 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, MetroPlus Health 's network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlus Health has been committed to building strong relationships with its members and providers.

Position Overview

The Senior Director of Quality Performance Improvement will participate in developing the vision and strategic direction for the Quality Management department. This position will work with the VP of Quality Management to design and execute the organization's quality improvement (QI) workplan and serve as a subject matter expert for HEDIS / QARR, CAHPS and HOS metrics, the NYS Department of Health (DOH) Quality Incentive Awards and CMS Star Ratings Program. The Senior Director has direction of a cross-functional team of clinical and non-clinical staff responsible for improving quality performance in preventive care, chronic care, behavioral health and member experience in all lines of business. This position will be the primary driver of the Plan's quality-based provider engagement strategy and provide clinical oversight of quality improvement interventions for members and providers.

The Senior Director of Quality Performance Improvement is also responsible for oversight of timely and satisfactory completion of regulatory projects and programs such as the Department of Health (DOH) Performance Improvement Projects (PIP) & Quality Matrix, the Medicare & UltraCare Chronic Care Improvement Project (CCIP) and support of the Medicare & UltraCare Model of Care (MOC). Participation in product line related audits pertaining to clinical and operational quality metrics are also under the purview of this role, such as Article 44 and Special Needs Plan

Model of Care audits.

Work Shifts

9 : 00 A.M - 5 : 00 P.M

Duties & Responsibilities

• Participate in the development of the vision and strategic direction for Quality Management; works with the VP of Quality Management in the design and execution of the organization's quality improvement (QI) workplan and serves as a HEDIS / QARR / STARS, CAHPS and HOS subject matter expert.
• Manage and lead cross-functional team to develop strategies, implement action plans, and oversee ongoing operational executions to meet corporate business goals for healthcare quality performance and cost containment.
• Drive the Plan's quality-based provider engagement strategy to close gaps-in-care and improve risk scores. Collaborate with network providers to ensure quality improvement projects are clinically sound, care is consistent with HEDIS / QARR requirements (including coding practices) and auxiliary data streams are established, if needed.
• With the CAHPS Director, design and execute an organization-wide, line-of-business specific quality improvement (QI) strategy for CAHPS metrics. Drives MetroPlusHealth's goal to provide top-tier experience to members through data-driven improvement activities and interdepartmental collaboration.
• Assists in the identification and alignment of quality measures selected for the MetroPlus Member Rewards Program, Provider Pay for Performance Program and Value-Based Programs with the regulatory quality incentive programs driving towards incentive maximization and continued improvement in member health outcomes.
• Leads the QI team's efforts to identify improvement areas, understand marketplace and member / provider behaviors, research member / provider barriers and validate them within the population, develop predictive models, perform root-cause analysis, and evaluate program effectiveness for quality performance metrics. Synthesizes multiple data streams for clinical and CAHPS metrics to identify high-risk members.
• Identify process improvement opportunities and provide guidance and direct oversight to automate processes, implement efficiencies, or execute needed changes.
• Maintain up-to- date knowledge and understanding of HEDIS / QARR / CAHPS measure technical specifications and CMS Star Rating measures, including HOS & Operational measures.
• Responsible for regulatory oversight of DOH Performance Improvement Projects and Matrices, the Medicare & UltraCare Chronic Care Improvement Project (CCIP) and the Medicare & UltraCare Model of Care (MOC), as well as any product line-related audits pertaining to clinical and operational quality metrics.
• Convene and lead work groups with external vendors and internal staff in support of quality measure improvement.
• Oversee evaluation of the effectiveness of interventions, dashboards, and operational performance indicators to better assess the organization's ability to meet quality targets. Track and report on initiative progress at all appropriate levels of the organization, including Quality Management Committee and Quality Assurance and Performance Improvement Committee.

Minimum Qualifications

Professional Competencie

Benefits

NYC Health and Hospitals offers a competitive benefits package that includes :

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