JOB PURPOSE:

This role comprises all quality and performance improvement functions across the organization, including participation building and supporting corporate shared vision to incorporate Organization’s goals with a data-driven culture and align with evidence-based best practices in compliance with CMS and NYS DOH requirements. Has oversight of the Quality Management Specialists and Supports, and the ongoing quality auditing work plan, which includes developing project plans, ensuring adherence to audit/project timeline, monitoring progress, and providing a status update to the various quality-led committees.

JOB RESPONSIBILITIES:

• Participates in redesigning the Quality Improvement Committee so that the plan conforms to Quality guidelines and requirements.

• Steers the development of the Quality Improvement Program, including implementation management, monitoring, and evaluation in collaboration with the Vice President of Quality.

• Develops performance improvement strategies in collaboration with senior leadership and clinical operations management.

• Develops, implements, and refines quality and safety programs through consultation, program activities.

• Participates in developing quality metrics to support performance improvement initiatives and quality/compliance oversight in conjunction with the VP of Quality and leadership.

• Designs, monitors, and evaluates performance and project improvement strategies to ensure gains and corrective action, strategic goals, and financial targets.

• Works in conjunction with business owners to assess opportunities for improvement and implement changes that will positively impact participant satisfaction.

• Collaborates with operations leadership to develop action plans based on quality reviews and root cause analysis findings.

• Oversees project work plans, including objectives, tasks, and time frames, to ensure deliverables are completed on time.

• Identifies and responds to changing project circumstances and communicates issues to leadership as appropriate.

• Makes recommendations to appropriate staff and committees about reviews, surveys, and study findings.

• Ensures corrective actions for regulatory issues, compliance, or deficiencies identified in participant complaints/incidents were implemented effectively.

• Serves as a subject matter expert to leadership, clinical operations management, and network providers in the areas of quality assessment and performance improvement initiatives with other stakeholders to drive quality management strategy.

• Facilitates and supports operational changes and activities which support quality improvement and clinical staff development goals.

• Designs and evaluates clinical support and education programs integrated with clinical operations and facilitates quality improvement strategic objectives.

• Ensures quality initiatives are aligned with improving the patient’s experience, improving the health of populations, and reducing the cost of healthcare.

• Functions as the quality liaison for developing analytic systems and databases that support quality improvement activities across the organization.

• Leads discussion and analysis of utilization and quality management trends through select committee participation.

• Revises/develops processes, policies, and procedures to address these trends.

• Leads monthly /quarterly reporting submissions to CMS and NYSDOH, ensuring data validity, accuracy, and timeliness.

• Collaborates on analyzing participant surveys for Medicare and MLTC and HOS-M survey for Medicare.

• Collaborates with other departments and staff on project implementation to maximize efficiency and teamwork.

• Develops strategy and related goals to ensure an optimal level of service delivery by contracted vendors.

• Works with vendor management staff to implement strategic plans for vendor management and performance improvement.

• Creates metrics to be used as part of an ongoing vendor evaluation process to determine vendor efficacy and consideration for contract renewal.

• Interfaces with data analytics leadership to ensure that the information systems provide the data for the measurement and assessment of vendor performance and improvement activities.

• Monitors member, provider, and staff complaints to identify elements of vendor performance that require immediate actions.

• Ensures effective staff training compliance and evaluates staff performance.

• Recommends staff training, hiring, promotions, terminations, and salary actions.

• Prepares and ensures adherence to the department budget.

• Recommends, implements, and monitors corrective action plans when needed.

Schedule: 8:30AM – 5:30PM

Weekly Hours: 40

QUALIFICATIONS:

Education: Requires a Bachelor’s degree in Nursing. A Master's Degree is preferred.                    

Experience:

• Minimum of five (5) years (in a leadership capacity) experience in quality improvement and measurement, health information management, strategic planning, performance improvement, and research in a managed care / Health Plan organization preferred.

• Project Management experience preferred.

• Requires knowledge of Federal and NYS regulatory requirements.

License: Current New York State license to practice as a Registered Nurse.

Additional Requirements:

• Experience working for or in long term care or a managed care setting.

• Project management skills are strongly preferred.

• Ability to lead and motivate others, develop project plans with corporate-wide impact, and work in team groups required.

• Proven strategic thinking, problem-solving, and analytical skills.

• Strong written, verbal, and interpersonal communication skills.

• Strong relationship building skills.

• Proficiency in training and staff development is preferred.

• Proficiency with computers, including Windows, Excel, Word, and PowerPoint, required.

Physical Requirements

Individuals must be able to sustain certain physical requirements essential to the job. This includes, but is not limited to:

• Standing – Duration of up to 6 hours a day.

• Sitting/Stationary positions – Sedentary position in duration of up to 6-8 hours a day for consecutive hours/periods.

• Lifting/Push/Pull – Up to 50 pounds of equipment, baggage, supplies, and ability to lift patients safely and using OSHA guidelines, etc.

• Bending/Squatting – Must be able to safely bend or squat to care for patients, use medical supplies, etc.

• Stairs/Steps/Walking/Climbing – Must be able to safely maneuver stairs, climb up/down, and walk to access work areas Position requires the individual to be able to travel, and walk between sites/locations and work areas throughout the day.

• Agility/Fine Motor Skills - Must demonstrate agility and fine motor skills to operate and activate equipment, devices, instruments, and tools (ie. typing, use of medical supplies, equipment, etc.)

• Sight/Visual Requirements – Must be able to visually assess patients, read orders type/write documentation, etc. with accuracy.

• Audio Hearing and Motor Skills (language) Requirements – Must be able to listen attentively and document information from patients, community members, providers, etc., and intake information through audio processing with accuracy. In addition, must be able to speak comfortably and clearly with language motor skills for customers to understand the individual.

• Cognitive Ability – Must be able to demonstrate good decision-making, reasonableness, cognitive ability, rational processing, and analysis to satisfy essential functions of the job.

Disclaimer: Responsibilities and tasks outlined in this job description are not exhaustive and may change as determined by the needs of the company.

 

We are an affirmative action and equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, disability, age, sexual orientation, gender identity, national origin, veteran status, height, weight, or genetic information. We are committed to providing access, equal opportunity, and reasonable accommodation for individuals with disabilities in employment, its services, programs, and activities.

Salary Range (Min-Max):

$130,000.00 - $150,000.00