VP of Quality Management

1 day ago

New York City, United States MetroPlusHealth Full time
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

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 network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlus has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.

The Vice President of Quality Management‘s primary function is to provide strategic and clinical leadership for the Quality Management (QM) Department, including Process & Quality Improvement, Health Promotion, Quality Risk Management, Quality Review Operations (HEDIS/QARR reporting), Consumer Satisfaction Surveillance of the Plan’s membership, Medicare Stars, Medicare Health Risk Assessment (HRA) and Model of Care (MOC) Processes and QM Member/Provider Outreach and Education. This position is responsible for oversight of the continued development and direction of the Quality Management Program and annual work plan in accordance with the policies and procedures established by the MetroPlusHealth Board of Directors’ Quality Assurance Performance Improvement Committee and the Plan’s Quality Management Committee.
Activities for which the Vice President is accountable include HEDIS/QARR reporting, Provider Pay for Performance Programs, MetroPlusHealth Member Rewards Program, Consumer Assessment of Healthcare Providers and Systems (CAHPS) and Health Outcomes (HOS) Surveys, Quality Improvement, including regulatory compliance projects such as the annual QIP, PIPs, CCIPs, NYS Quality Improvement Action Plans, etc. This position is also a key participant in the development of provider VBP arrangements, clinical measure improvement and risk projects to improve risk scoring in various lines of business.

Job Description
  • Oversees the development of the Quality Management Program Description, annual work plan and evaluation in conjunction with the Director of QI and the QM Committee.
  • Actively participates in the Quality Assurance Performance Improvement Committee of the Board of Directors. Serves as a voting member of the Quality Management Committee, Utilization Management Subcommittee, Behavioral Health Joint Quality and UM Subcommittee, Appeals and Grievance Subcommittee, and Member Advisory Subcommittee.
  • Oversees the interaction and reporting processes of the Quality Management Performance Improvement Committee of the Board of Directors and the Quality Management Committee and various MetroPlusHealth QM Subcommittees. Prepares Board and QI Program updates as needed.
  • Works with the Plan’s analytics department to partner with community based primary care practices to reduce nonusers and appropriate follow up of those with chronic conditions.
  • Leads the development and implementation of quality improvement initiatives and interventions and programs to address member needs, member satisfaction (CAHPS), patient
    safety concerns and to improve the overall health of members. Leads cross-functionally to ensure QI across the organization.
  • Leads the identification and alignment of quality measures selected for the MetroPlusHealth 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.
  • Serves as the principal quality liaison between MetroPlusHealthand NYC Health + Hospitals’ Quality Improvement activities.
  • Interfaces with and represents MetroPlusHealth to facilities, providers, vendors, associations, and regulatory entities.
  • Responsible for overseeing HEDIS/QARR annual production and reporting for all lines of business ensuring maximization of data collection (i.e., supplemental data, claims data, encounter data, medical records, etc.) captures all sources.
  • Oversees the quality-of-care audits and surveys developed by the regulatory agencies, MetroPlusHealthand the Medical Directors.
  • Leads the development of Provider Incentive Programs including but not limited to Pay for Performance and targeted/ad hoc quality incentive programs as identified throughout the year.
  • Leads the development of clinically related Member incentives via the MetroPlusHealth Rewards Program. Responsible for all aspects of the Program related to clinically oriented measures including day to day operational oversight and improvement.
  • Key participant in strategic workgroups designed to shape and support overarching organizational goals as they relate to quality.
  • Acts as a liaison between all departments at MetroPlusHealth regarding Quality Improvement activities.
  • Leads the Plan’s Health Information Exchange (HIE) strategy. Identifies HIE entities, e.g., RHIOs, and optimizes/manages relationships and data flow to positively impact quality performance.
Minimum Qualifications
  • A Master’s Degree with a specialization in Health Care, Business or related field required.
  • 10-15 years of senior-level related professional, technical and management experience. Managed Care experience strongly preferred.
  • Knowledge of and experience with managed care and medical care delivery systems, UM, QM, HEDIS/QARR, CMS Stars, HOS, CAHPS, Contracting required.
  • Clinical license (RN, NP, MD, etc.) with 5+ years clinical experience preferred.

Professional Competencies

  • Strong leadership and management skills
  • Able to function in ambiguous situations with minimum direction
  • Able to negotiate political and operational hurdles without losing personal effectiveness
  • Ability to transfer knowledge, coach and develop leadership team skills and business insight
  • Integrity and Trust
  • Customer Focus
  • Knowledge of HMO regulation, accreditation, and quality management processes.
  • Excellent written/oral communications skills

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