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Director, Payer Quality Performance

4 months ago

BWI Airport, United States The University of Maryland Medical System Full time

The University of Maryland Medical System is a 14-hospital system with academic, community and specialty medical services reaching every part of Maryland and beyond. UMMS is a national and regional referral center for trauma, cancer care, Neurocare, cardiac care, women’s and children’s health and physical rehabilitation. UMMS is the fourth largest private employer in the Baltimore metropolitan area and one of the top 20 employers in the state of Maryland. No organization will give you the clinical variety, the support, or the opportunities for professional growth that you’ll enjoy as a member of our team. Job Description

General Summary This role will be responsible for the direction, program management and evaluation of quality performance measures. They will guide a team that identifies trends and make recommendations for clinical and operational quality improvement initiatives. Responsible for the management of quality reporting and compliance for multiple payer programs across the enterprise organization. This position supports the design, implementation, and maintenance of a comprehensive provider network/population health quality performance strategies that includes aligning multiple physicians and UMMS systems. This includes organizing and managing teams, developing project plans and schedules, managing issues, risks, costs, managing to schedule and scope and communicating at all levels of the organization. Manage staff during all aspects of the quality measure life cycle. This role should function as a recognized mentor, quality and regulatory role model. Provides clinical outcomes expertise through analysis of population health data (clinical quality measures) extracted from practice EHR, payer data and patient experience data. Serves as a lead in identifying health care trends in health outcomes, utilization, population and disease management, and patient experience. Partners with end users to identify their reporting needs and solutions. Principal Responsibilities and Tasks The following statements are intended to describe the general nature and level of work being performed by people assigned to this classification. These are not to be construed as an exhaustive list of all job duties performed by personnel so classified. 1. Serves as a leader between population health/payer quality programs; prioritizes problems for effective and timely resolution, and develops/communicates resolution plan/approach and recommendations. 2. Provides operational leadership to payer quality and population health programs and staff, while able to seamlessly manage projects as indicated leadership. 3. Responsible for managing assigned teams (internal staff as well as team members in other departments) to ensure project plan objectives remain on target and are achieved in accordance with the action plan deadlines 4. Oversees implementation plan development and coordination of resources to execute the plan In conjunction with clinical and administrative leaders, develops key priorities for advancement of clinical integration relative to program development and clinical quality improvement 5. Supports system-wide governance and committee infrastructure for payer quality programs 6. Works closely and in collaboration with leadership throughout organization, including practice transformation, clinical integration, finance, payer relations, performance improvement, care management, patient experience, marketing and communications, internal and external partners to set the strategic direction for program development, performance improvement and resource deployment 7. Understands UMMS population health vision, goals and strategies and communicates to others. Able to set clear goals and directions. 8. In conjunction with local hospital and practice quality leaders and clinical integration, supports the development of population-based registries, clinical practice guidelines, and evidence-based quality measures aimed at establishing, measuring and monitoring a high standard of clinical excellence for our patients. 9. Regularly communicates progress and impact to key stakeholders and senior leaders through KPIs and other scorecard tools. 10. Determines staffing requirements and directs the work of all direct reports to ensure effective and efficient departmental functions. Serve as resource, primary advisor, and mentor for all direct reports and cascading teams. A. Hires, orients, trains, conducts performance evaluations, handles disciplinary issues, and provides an open and goal oriented work environment with establish clear and concise work procedures and productivity standards. Conducts performance reviews, and holds employees accountable for optimal performance of their responsibilities. B. Develops personnel by providing opportunities and training programs to enhance individual employee’s career development. C. Ensures full staff competency of technologies, regulations, policies and practices across the division. D. Manages activities of contractors. 11. Implements and enforces departmental policies and procedures. A. In coordination with departmental management, ensures compliance with regulatory and audit agency requirements. B. Develops performance improvement initiatives aimed at improving customer service, operating costs, departmental functions/departmental productivity. C. Develops and executes effective control process and compliance monitoring procedures to ensure risks are measured, monitored, controlled, and mitigated. D. Represents the department at various meetings, task force groups, quality councils and with other members of the UMMS/QCN. 12. For complex projects or programs, direct the initiative using best-practice program management approaches to deliver against approved estimates for quality on-time and on-budget programs and projects. 13. For programs consisting of multiple subprojects, directs the deployment and organization of resources, including the mentoring of project coordinators and project managers. Ensure development of timetables and targets and check progress against them. Direct the plans of activities; ensures a plan which streamlines the program process. 14. Meet with stakeholders and executive to review solution and issues and to gain commitment on recommendations related to quality payment programs. 15. Exhibits mastery of reporting projects, data manipulation and analysis related to quality payment programs. Provides mentorship. 16. Direct project managers to use the commonalities/differences within the team members’ goals, values and problem-solving styles to generate multiple alternatives in leading group to achieve a result and monitor for effectiveness. Ensure program impact does not negatively impact or interfere with others. Qualifications

Education and Experience Master’s degree in Business, Nursing, Policy, Health Care Administration or a related discipline; or equivalent combination of education certifications and work experience is required. Clinical experience preferred. Five (5) years of progressive supervisory/management experience in a healthcare environment is required. Experience with various Quality Reporting programs (PQRS, MU, VBM, MIPS) is required. Experience with management and/or engagement with national quality organizations, including National Committee of Quality Assurance (NCQA) structure and standards and Health Plan Employer Data and Information Set (HEDIS) and National Quality Forum (NQF) is required. Experience with electronic health record (EHR) data extraction, registry and/or functionality is required. Previous experience in leading a project and/or team is required. Knowledge, Skills and Abilities 1. Demonstrated ability to manage large scale project and/or program teams. Ability to set up, plan, manage, report and communicate medium size projects and direct the completion of projects within proper scope, budget and schedule. 2. Demonstrate ability to think strategically. Demonstrate sufficient understanding of some functions to structure and manage project work. Generate innovative and practical solutions to complex or unusual problems. 3. Support client relationship management and oversees Population Health/Quality project execution and reporting. Possesses excellent customer service skills. 4. Act as lead resource for dealing with project issues, ability to lead projects. Understands appropriate escalation process. Work with the team to make decisions considering the degree of impact on areas involved. Demonstrated ability to reach agreement and potential solutions through flexibility and compromise with peers, customer/client, and managers. 5. Proficiency in the use of personal computers and related peripheral equipment is required. Familiarity with Microsoft Office products and Microsoft Project is preferred. 6. Structure and manage projects to meet/exceed patient, provider and organizational expectations, deliver value and minimize potential obstacles and risks. Understand and manage stakeholder needs and build commitment to project solutions that deliver target business & clinical value. 7. Highly effective verbal and written communication skills are necessary in order to work with all levels within the organization, and produce clear and concise reports of relatively complicated issues. Working Conditions Weekend, shift work, holiday, on-call, and may be require work beyond normal tour of duty to complete projects, meet deadlines, or respond to emergencies. Work is performed in various environments within UMMS and practices. Work may include regular travel to and from the various affiliated institutions within the Medical System/UMQCN. Work may be required in a Healthcare facility which the observance of “Universal Precautions” is mandated. Universal Precautions involves the wearing of protective clothing/equipment and the observance of safe work practice. Work is high demand and fast paced. Talking and hearing necessary for conversations with callers, visitors, patients, families and staff members. Additional Information

All your information will be kept confidential according to EEO guidelines.

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