Manager of Behavioral Health Quality
7 days ago
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 Overview
The Manager of Behavioral Health Quality defines and strategically formulates the organization's Quality Improvement (QI) strategy for Behavioral Health (BH) metrics. The position manages and leads a cross-functional team to design, implement and evaluate QI initiatives and/or data mining/research activities to improve quality performance as defined by NCQA, DOH, CMS and other regulatory bodies while working closely with the BH Care Management, Pharmacy, and other departments to ensure resources are properly allocated to address performance deficiencies in key metrics. The Manager of Behavioral Health Quality is responsible for ensuring a quality strategy that is organized, coordinated, and measured, and designed to maximize performance in the state's Quality Incentive Award (QIA) programs, with special attention paid to the organization's Health and Recovery Plan. To succeed in the role, candidates must:
- Be self-motivated and able to work in a fast-paced, dynamic work environment.
- Possess strong attention to detail and technical abilities.
- Be organized and able to meet deadlines.
- Demonstrate strong communication skills.
- Defines and strategically formulates MetroPlusHealth's member/provider Quality Improvement (QI) strategy for Behavioral Health (BH) metrics and supports the organizational goal to provide top-tier Behavioral Health services. Effectively and efficiently manages all QI strategy projects.
- Manages QI Specialists in the design, implementation, and evaluation of quality and process improvement projects required to support HEDIS/QARR and other regulatory projects. Oversees Clinical Outreach Specialist team to ensure high-risk members are engaged and connected to appropriate services.
- Drives data analytics efforts to identify improvement areas, understand marketplace and member/provider behaviors, perform root-cause analysis, and evaluate program effectiveness for BH metrics. Able to provide innovative solutions to critical problems and foster a like-minded approach amongst direct reports.
- Identifies industry trends to ensure QI strategy keeps pace with planned or expected changes to state/federal quality reporting programs.
- Key player in developing member and provider incentives for BH metrics.
- Aligns internal/external action plans and workstreams with the organization's QI strategy. Evaluates effectiveness of such programs and improves as needed.
- Drives the provider strategy for improving quality performance in BH metrics. Conducts meetings with high-volume high-impact provider groups, shares performance data, and collaborates on performance improvement
- plans. Assists in establishing linkages between inpatient and outpatient BH care across BH and medical providers.
- Develops tools for and supports physicians, provider groups, etc. in addressing quality gaps-in-care and drives healthy outcomes for specific diseases.
- Partners with the physicians, provider groups, etc. to ensure data integrity/completeness pertaining to rendered services. Creates electronic data streams as needed.
- Monitors and manages quality and performance improvement project(s) and other regulatory projects, including documenting performance indicators, outcomes measures, process measures, procedures, interventions, and reporting to CMS/DOH/IPRO.
- Drive ad-hoc projects that serve to educate and build provider awareness of behavioral health aspects of care and support other state and plan initiatives requiring provider education.
- Actively participates in quality committees or workgroups such as the Health Status Improvement Team (HSIT) Workgroup.
- Develops and delivers intra-department trainings.
- Consistently applies PDSA methodology to all quality improvement work
- Master's degree in a clinical field required.
- Must have a minimum of 10 years' experience in the health care field. Experience must include both clinical and Managed Care.
- 5 years' experience managing staff required.
- Superior project management and documentation skills.
- Must be an expert in HEDIS and QARR requirements.
- Experience with and proficiency in data analysis required. Working knowledge of relational database and statistical analyses is a plus.
- Must be familiar with and have a working knowledge with Quality Improvement process improvement methodology strategies including but not limited to PDSA and DMAIC.
- Must be proficient in Microsoft Word, PowerPoint, Excel, and Access
- Active licensed RN, LPN or LMSW/LCSW in NYS required.
- Six Sigma Yellow or Green Belt preferred.
- Ability to lead and manage others.
- Must possess analytical skills to collect, organize, and present data in a clear and concise manner.
- Ability to assess all work and prioritize as necessary to meet reporting timeframes and deadlines.
- Demonstrated problem solving skills.
- Ability to work in a fast-paced environment with changing priorities.
- Superior oral, written and communications skills.
- Ability to understand and communicate analytic and clinical data to varied audiences.
- 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 within the team.
- Must have integrity, fostering an honest and trusting relationship with co-workers and management, never compromising the Plan, other employees, or self for personal gain.
- Solid analytical and logical skills paired with strong attention to details.
- Must be a versatile, quick learner, who is open to change and enjoys the challenge of unfamiliar tasks.
- Must seek to continuously improve processes for the benefit of the customer by taking personal responsibility for the resolution of customer services.
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