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Quality Management Analytics Manager
2 months ago
Quality Management Analytics Manager / Hybrid
The organization is offering generous benefits and a salary up to $130,000.
Position Overview
- Provide supervision of the QM Analytics Team, which includes four Analysts. The team independently maintains the HEDIS/QARR 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.
- Managing the end-to-end process of integrating claims, provider, member, encounter, and supplemental data into quality measure rates.
- Collaborates with all levels of the organization including our largest provider and works closely with appropriate vendors. The vendors include, but are not limited to: HEDIS software vendor, member rewards vendor, communications vendor, and provider and member portal vendor, as well as the CMS and NY state-mandated vendors for data transmission.
- Retains responsibility for the development of program forecasting models and actual and predictive quality program dashboards to ensure provider pay for performance program budgets and QM/Plan quality goals are identified, tracked, and met.
- Mentors and trains analytics staff on all applications and processes and develop strategic plans to ensure deadlines are met, while still maintaining data integrity.
- Guides and works with Quality Improvement Specialists to ensure data requests are aligned with project needs, interpretation of data is correctly interpreted & reported.
- Oversee duties tied to the development of new programs and initiatives as assigned by the Director of QM Analytics.
- Responsible for developing and maintaining processes to implement, test, and validate supplemental data collected from providers
- Communicate, as needed, with the NYS or Departments of Health on relevant analyses.
- Provides technical mentorship to QM Provider Engagement, Quality Review Leads and Quality Improvement Specialists
- Functions as mid-level escalation support for all applications; Escalate data issues needing process re-engineering.
- Selects, develops, manages, and evaluates direct reports.
- Mentors the data team in leading system implementation (i.e., new modules, upgrades, product installs).
- Communicates clear instructions to project team members. Coaches and mentors team members and monitors team members’ performance and key project benchmarks.
- Relationship Management
- Supports productive inter/intra departmental and vendor work relationships. Specifically, HEDIS vendor relationships, including HEDIS software vendor and Health Exchange Registries. Manages vendor relationships to ensure deadlines and deliverables are met.
- Interfaces with key IT, clinical, business and operations staff to develop efficient workflows. Analyzes business operations as they relate to decisions and proposes improvements where possible.
- Retain subject-matter-expert knowledge of health plan programs and HEDIS/QARR/QRS specifications.
- Ensure health plan is in compliance with government and agency regulations as they relate to NYS DOH, CMS, NCQA standards for required data submissions.
- Reporting & Analytics
- Responsible for providing quality initiative analytics for Quality Management. Supports provider and member interventions impacting quality with ongoing and ad hoc reports.
- Supervision of the QM Analytics team. Guides and mentors, the team in utilizing new and existing functionality for projects by ensuring deployment with a focus on timeliness, efficiency and consistency across analysts.
- Ensures 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.
- Establishes reporting and analytics strategies and ensures they are integrated into scope and delivery of projects in accordance with IT project standards and best practices. Promotes 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.
- Manages and delivers 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. Trains staff as necessary.
- Other duties as assigned by Director of QM Analytics.
- Bachelor’s degree in public health, health administration, business administration or information technology required. Master’s degree preferred.
- A minimum of 5 years’ programming, application or reporting development experience and analytical experience (SAS, SQL, Crystal Reports, etc.).
- Experience using analytics / BI packages (e.g., SAS, R, SQL, Cognos, Business Objects) to build client analysis solutions.
- Must have advanced working knowledge of Microsoft Office applications including Word, Excel, PowerPoint, Visio, and Access.
