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Now hiring for the following position. To apply, please e-mail a cover letter and resume to: email@example.com
Quality and Performance Manager
Under the supervision of the Chief Operating Officer, the Manager of Quality and Performance has overall responsibility for maximizing and improving quality and oversight and execution of performance improvement efforts related to Starling’s value-based agreements and risk contracts in all lines of business. The Manager will assist in setting goals and priorities in support of successful contract performance and will serve as subject matter expert in performance improvement methodologies and process development. The Manager will also have responsibility to convene teams and workgroups to address opportunities and focus on priorities and facilitate solution and brainstorming sessions to achieve goals and maximize quality performance. Position will work with the COO to manage and implement quality strategies, payer collaboration, payor submissions and quality auditing, as needed. Position will also partner with the Manager, Care Management to develop effective strategies to manage utilization and improvement contract performance as it relates to medical cost management.
- Knowledge expert as it relates to:
- Clinical quality metrics included in value-based contracts
- Clinical quality and claims-based metrics (i.e. HEDIS) for Medicare Shared Savings (“MSSP”) ACO, weighting, point values
- CMS guidance and metric definitions and assists Data/Reporting team and Contract Performance in developing reports and dashboards to appropriately monitor progress
- Payor submissions for Medicare, Commercial and Medicaid contracts
- Responsible for oversight of quality metrics, gap closures and processes by which to do so for all APM contracts, including
- Devising strategies for GIC closure
- Oversee and help develop reporting for leadership, providers, and staff
- Developing processes to use reports, including providing education, tip sheets, and or shoulder to shoulder collaboration with practice staff and providers
- Collaborating with EHR team to facilitate gaps in care (“GIC”) closure and network quality analysis (e.g., standard supplemental data submission)
- Responsible for MSSP quality, including
- Collaboration with existing MSSP ACO leadership to leverage reporting and develop improvement plans
- Participate in existing activities and/or partner to build new risk adjustment strategies that aim to accurately reflect illness acuity of attributed lives
- Coordinating and deploying resources for education
- Participate in targeted projects or audits
- Overseeing processes related to chart pulls and practice support to achieve supplemental data submission goals
- Serve as subject matter expert in performance improvement methodologies and process development
- Coordinate and facilitate workgroups and teams to tackle initiatives and projects where performance opportunity exists
- Coordinate quality improvement efforts with overall needs and goals of the company
- analyze data for improvement opportunities
- Able to effectively collaborate to achieve optimal performance and clinical integration
- With Primary Care Provider, specialists as needed and Starling Leadership
- With Care Management staff to close GIC and ensure appropriate reports are available for GIC outreach
- With APM Contract Performance to monitor performance and ensure quality gates and thresholds are met
- Has responsibility for helping to coordinate and manage regular Joint Operating Committee (JOC) meetings with payers. Work with payors to establish meeting agendas, coordinates internal cross-departmental internal meetings to prepare for payor meetings.
- Leads value-based payment and alternative payment model projects. Facilitates the group process with senior administrators and faculty. Perform sophisticated analysis including developing financial and operational models, evaluating contract performance, environmental trends, core capabilities, competitive profile and creating a gap.
- Develops Board documents and analyses as requested.
- Builds strong relationships with external payers and internal leadership and staff to support optimal patient care, service delivery, payment, program compliance, and data validation.
- Evaluates local and national managed care issues trends related to care transformation innovative payment models. Identifies contract and program opportunities, regulatory changes, industry practice changes that can potentially impact revenues and operations.
- Supervises direct report(s) & other duties as assigned.
Relationships (Reports to, Supervises)
- Reports to Chief Operating Officer.
- Establishes and maintains effective working relationships with providers, managers, other administrative staff, vendors, patients and public.
- Supervises Value Based Quality Coordinators.
Qualifications (Education, Experience, Additional Skills & Requirements)
- Bachelor’s degree required; MPH, MBA or MHA or other relevant Master’s-level degree preferred
- 3-5 years of healthcare experience, preferably in an ambulatory health care or ACO/value-based environment
- Minimum 3 years of quality, performance improvement, practice transformation or data management experience required
- Must have considerable knowledge of health care organizations, operations, finance, quality, program planning, and managed care.
- Basic understanding of provider contracting, provider development, delivery system design, quality and medical cost management
- Prior experience with value-based/alternative payment models.
- Demonstrated project management skills with experience managing and supervising projects
- Strong leadership and management experience and ability to supervise staff
- Excellent organizational skills required, with the ability to communicate and work collaboratively with all levels of staff, payors, providers and office staff, and effectively utilizing all resources available.
- Ability to interact effectively with all levels of administrative and medical staff and to facilitate the progress of multidisciplinary personnel teams in the pursuit of common goals and objectives.
- Requires knowledge of analytic software including spreadsheet (Excel), database (Access), and presentation (PowerPoint) programs, with strong aptitude for learning additional software.
- Must possess sharp analytical skills and strong organizational skills, have excellent communication skills and have the ability to create clear and articulate correspondence and documents.
- Independent thinking, resourcefulness and excellent problem-solving skills are required.
- Strong analytical, creative, organizational, and interpersonal skills are required as are being hands-on, versatile, and a self-starter.
- Must be a team player comfortable working in a fast-paced organization.
- Must have the ability to teach complex concepts to users at all levels.
Working Conditions, Physical Requirements
- Office environment.
- Incumbent may be required to work at any Starling facility based on operation need, and schedule may vary.
- Travel may be required to various practice locations requiring the ability to drive, a valid driver’s license, and use of own reliable transportation.
- Physical activity will include walking, standing, and sitting.
- Physical demands may also include lifting and carrying equipment up to 30 lbs. or providing physical assistance to patients.
- Other physical requirements include speaking and hearing ability sufficient to communicate effectively by phone or in person at normal volumes; vision adequate to read correspondence, computer screen, forms, etc.; and good manual dexterity.
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
To apply, please e-mail a cover letter and resume to: firstname.lastname@example.org.