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, 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 primary function of the Quality Improvement Project Specialist is to provide leadership in developing, implementing, monitoring, and coordinating quality improvement initiatives that support the goal of improving quality measures across all lines of business. This position will work directly and collaboratively across all MetroPlusHealth departments and with Provider Groups/Facilities to achieve Plan goals for improving assigned quality measures. This position will serve as the subject matter expert for a defined set of quality measures. 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
• organized and able to meet deadlines
• demonstrate strong communication skills

Job Description

• Lead the development of root cause analysis, interventions and action plans, project planning, tracking and outcome summary reports.
• Monitor and analyze quality measures and interventions to ensure goals, objectives, outcomes are met.
• Monitor for adverse trends, recommend modifications and corrective actions. Develops interim data collection mechanisms to track performance.
• Ensure focus on priority measures that are important for achieving/maximizing quality
• incentive programs established by regulatory bodies including but not limited to CMS, NYS DOH, etc. This may differ by line of business.
• Communicate measure interventions and results to external entities in accordance with applicable program objectives, policies, and procedures.
• Lead and coordinate measure improvement specific meetings with key stakeholders (internal and external business partners) with regular frequency to achieve quality goals.
• Provide reporting to Manager/ Director and/or health plan leadership on progress of overall measure performance.
• Lead/participate in external activities, work group or committees promoting quality goals.
• Participate in relevant committees and work groups; make presentations, prepare reports, data or other materials for committee presentation.
• Coordinate the development and maintenance of a workplan for all assigned quality measures. This includes, but is not limited to, analyzing competitor and best in class Plan
• performance to obtain insight into potential interventions that can improve MetroPlusHealth performance.
• Assist in the maintenance of contracts to administer various aspects of QI interventions.
• Participate in special projects as needed. This may include but is not limited to required projects to satisfy regulatory requirements.

Minimum Qualifications

• Bachelor's degree in analytical field including Finance, Health Care Management, or related field; Master's Degree a plus
• Three to five years' experience in any analytic field
• Two to three years of managed care experience preferred
• Understanding and knowledge of HEDIS, QARR, Star measures strongly preferred
• Knowledge of quality improvement processes such as PDSA preferred
• Must have strong working knowledge of Microsoft Office applications including Word, Excel, Access, and PowerPoint
• Experience with relational database/statistical applications (MS Access, SAS, or R) strongly preferred
• Project Management certifications such as Six Sigma or PMP preferred

Professional Competencies

• Integrity and Trust
• Customer Focus
• Functional/Technical/Analytical Skills
• Written/Oral Communications

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