Job #: 1795
Title: Quality Management
PURPOSE OF THE POSITION:
To ensure continuous improvement in all corporate-wide technical and business aspects of HEDIS/QARR reporting and measure performance improvement in accordance with NYSDOH guidelines as well as analysis of information, coordination of initiatives for data quality with providers and operations staff, and integration of Plan data needs.
In collaboration with the Senior Programmer, designs and builds tailored relational databases, including updating and maintenance of HEDIS/QARR database for annual reporting to the NYSDOH and effective coordination and processing of information based on analysis of data sources and departmental needs.
Coordinates the generation of the HEDIS Roadmap for HEDIS/QARR Audit by NYSDOH; works closely with the auditors, vendors and internal Affinity staff to prepare for and successfully complete all aspects of the Audit; ensures that all queries and follow up items resulting from the audit are answered timely and satisfactorily.
Coordinates with the HEDIS/QARR software vendor to update software, obtain data files and supporting documentation in preparation for data collection and compilation; monitors the completeness and accuracy of data collected and compiled in the databases and generates regular progress reports for QM Department staff.
Conducts tracking, trending and reporting of all HEDIS/QARR membership and utilization- related data; prepares and presents reports for internal and external committees and customers; maintains, contributes to the revision of departmental and corporate policies, procedures and protocols.
Participates in the organization, coordination and implementation of performance improvement activities, including HEDISQARR projects, as assigned; assists with the design and development of healthcare data retrieval tools, flow charts and review processes for HEDIS/QARR and other quality improvement monitoring activities; collaborates in the development and maintenance of databases for quality improvement studies;
Analyzes and evaluates administrative and clinical data and produces effective presentations and documents, making recommendations about methods and protocols to ensure effective, efficient quality improvement strategies for data processing/management as it relates to the QM Department’s need for, and use of, the Plans’ business information.
Supports the development and implementation of performance improvement initiatives by the QIC/QMS staff; interprets and analyzes clinical study data submitted by providers and/or entered by QM staff and quantifies into formats for standardization and reporting for internal/external customers.
Collaborates with internal/external customers to facilitate continual quality improvement in submission and processing of accurate, complete and timely data to meet both internal and external customer needs.
Understands the different Affinity databases and their inter-relationships; develops the capability to use multiple sources of information to locate member charts for various quality improvement initiatives.
Runs reports of all targeted activities, produces tracking and trending reports of progress on all projects; prepares summaries for meetings; presents data reports as required and produces educational documents for providers around technical issues.
Trains staff on various databases and software applications as per project requirements; develops, tests and administers training tools to achieve objectives of orientation, knowledge and skill enhancement required to accomplish quality improvement goals; contributes to the creation, updating and maintenance of training manuals, reference guides, and user manuals for commonly used applications and databases.
Supports data management needs for the Quality Measurement Analysis and Reporting Unit activities, including HEDISQARR, MEDSII, CMS studies, credentialing, etc.
Interfaces effectively with Affinity Health Plan providers and staff as a facilitator, resource, educator, problem-solver and collaborator for all QARR-related quality management projects; represents Affinity to external customers, especially NYSDOH regulatory agencies by overseeing execution of all mandated activities and projects to a timely and successful conclusion;
Demonstrates proficiency with the principles and methodologies of process improvement.
Applies these in the execution of responsibilities in support of a process focused approach.
Performs other duties as necessary or assigned.
BA/BS in related field or equivalent knowledge; Masters Degree in related field preferred
Minimum of two years experience in a managed care setting
Minimum of two years Medicaid HEDIS/QARR reporting experience
Knowledge of QM/CQI principles, NYSDOH and NCQA/JCAHO standards and regulations
Experience with data analysis and reporting, and performance improvement methodology
Excellent analytical, data manipulation/management, verbal, written, organizational and interpersonal skills
Demonstrated ability to prepare effective presentations and layouts
Expert level proficiency with Microsoft Office applications including Word, Excel and Access; familiarity with Facets or other business system preferred
Effective interpersonal skills characterized by diplomacy to foster effective collaboration and cooperation with internal (operations) and external (providers) customers
Familiarity with HEDIS software preferred
Some programming experience with dBase, FoxPro, Paradox, Access, Visual Basic and Excel desirable
Administrative experience in a health care environment and project management experience highly desirable