Manager Ma/ri Network Quality and Cca Provider and

4 weeks ago

Boston, United States Commonwealth Care Alliance Full time

**Why This Role is Important to Us**:
Reporting to the Sr Director, **Quality Performance and Value Based Care,**

the Provider and Facility Quality & Safety Manager is responsible for designing and executing quality measurement and improvement programs and is responsible for managing and implementing key population health and network quality initiatives to achieve high performance on CCA's Population Health goals; including Medicare Star measures, Medicaid-Medicare Plan withhold measures, quality performance metrics incorporated into other CCA contracts, health equity, and social determinants of health (SDOH) measures.The Manager of Provider and Facility Quality and Safety to improve the care we provide, thereby driving better care at lower cost, and helping members. will be the essential expert on compiling, reporting, and supporting facilities in improving the quality of care and member outcomes.

**Supervision Exercised**:Yes

**What You'll Be Doing**:

- Manager of Provider and Facility Quality & Safety is responsible for the planning, organization,and successful execution of one or more quality programs for the Market Region
- Leads, designs, manages, and executes value based care quality improvement and safety programs with support from the Sr Director, **Quality Performance and Value Based Care**:

- Ensures the quality and timeliness of work performed, supervises, and assists in the gathering of data (supplemental or otherwise) and the accurate entry into all systems and subsystems
- Develops and manages in conjuction with Sr Director, **Quality Performance and Value Based Care, **the Facility Performance Incentive Programs. Work with network contracting and the finance department to develop, track contract deliverables and execute quality payments for the value-based care contract programs.
- Review and analyze data to assess facility network utilization and quality performance and safety. Trends in data, compiles statistics, and runs reports weekly, monthly, and quarterly for quality and patient safety to identify opportunities for improvement.
- Collaborate with business stakeholders from population health, network strategy, quality analytics, clinical informatics, clinical, pharmacy, member experience, and behavioral health teams to improve network performance and quality of care provided to members.
- Participates in medical record chart reviews as the primary means of determining quality and safety trends; works to develop and implement improvement projects as needed.
- Presents findings to contracting, provider engagement, clinicial leadership to identify actionable next steps to help inform data-based decisions and improvement.
- Monitors key performance metrics to inform future onboarding and training efforts and improve clinical delivery.
- Demonstrates the ability to work on multiple, complex projects and manages communication between partner quality staff, providers, health plans, market leadership and enterprise
- Build relationships and motivates facility quality staff to achieve long
- range and short term operational goals
- Coordinate resources and team members required to meet the business objectives
- Manage the resolution of problems that are escalated
- Influences senior leaders on opportunities to improve quality in order to drive health outcomes, lower costs, and improve experience for members and providers. Works closely with senior leaders to solicit input, guide data-backed problem-solving, and make recommendations to advance the clinical quality strategy.
- Establishes effective and collaborative working relationships with stakeholders
- Keeps current with emerging trends in hospital quality, safety, and clinical compliance, and integrates key concepts into daily operations.
- Supports an institutional culture of safety and non-punitive reporting aligning with High-Reliability principles.
- Performs other related duties as assigned.

**Working Conditions**:

- Standard office conditions.

**What We're Looking For**:
Education Required:

- Bachelor's Degree in Public Health, Health Administration, or other relevant field.

Licensing Desired:

- Licensed RN
- Certified Professional in Healthcare Quality (CPHQ) or Project management Professional (PMP)

Experience Required:

- Experience working with a not-for-profit payor and provider.
- Familiarity with home-based or mobile care models.

Knowledge, Skills & Abilities Required:

- Experience and comfort working with a wide-variety of people with different skills, positions and communication styles.
- Experience and understanding in knowing when to escalate issues to program leadership.
- Experience managing cross-functional teams and projects
- Flexible and creative in developing working relationships with internal and external partners
- Possess excellent skill and instinct at employing a variety of communication techniques
- Ability to identify system problems and creatively facilitate processes to come up with solutions.

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