Job DescriptionJob DescriptionEmpower. Unite. Care.pstrongMetroPlusHealth/strong is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day./pAbout NYC Health + HospitalspMetroPlusstrongHealth /strongprovides 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, MetroPlusstrongHealth/strong has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life./ppstrongPosition Overview: /strong/ppEmpower. Unite. Care. /ppMetroPlusstrongHealth/strong is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day. /ppThe Senior Director of Quality Performance Improvement will participate in developing the vision and strategic direction for the Quality Management department. This position will work with the VP of Quality Management to design and execute the organization’s quality improvement (QI) workplan and serve as a subject matter expert for HEDIS/QARR, CAHPS and HOS metrics, the NYS Department of Health (DOH) Quality Incentive Awards and CMS Star Ratings Program. The Senior Director has direction of a cross-functional team of clinical and non-clinical staff responsible for improving quality performance in preventive care, chronic care, behavioral health and member experience in all lines of business. This position will be the primary driver of the Plan’s quality-based provider engagement strategy and provide clinical oversight of quality improvement interventions for members and providers. /ppThe Senior Director of Quality Performance Improvement is also responsible for oversight of timely and satisfactory completion of regulatory projects and programs such as the Department of Health (DOH) Performance Improvement Projects (PIP) amp; Quality Matrix, the Medicare amp; UltraCare Chronic Care Improvement Project (CCIP) and support of the Medicare amp; UltraCare Model of Care (MOC). Participation in product line related audits pertaining to clinical and operational quality metrics are also under the purview of this role, such as Article 44 and Special Needs Plan Model of Care audits. /pJob DescriptionulliParticipate in the development of the vision and strategic direction for Quality Management; works with the VP of Quality Management in the design and execution of the organization’s quality improvement (QI) workplan and serves as a HEDIS/QARR/STARS, CAHPS and HOS subject matter expert. /liliManage and lead cross-functional team to develop strategies, implement action plans, and oversee ongoing operational executions to meet corporate business goals for healthcare quality performance and cost containment. /liliDrive the Plan’s quality-based provider engagement strategy to close gaps-in-care and improve risk scores. Collaborate with network providers to ensure quality improvement projects are clinically sound, care is consistent with HEDIS/QARR requirements (including coding practices) and auxiliary data streams are established, if needed. /liliWith the CAHPS Director, design and execute an organization-wide, line-of-business specific quality improvement (QI) strategy for CAHPS metrics. Drives MetroPlusstrongHealth/strong’s goal to provide top-tier experience to members through data-driven improvement activities and interdepartmental collaboration/liliAssists in the identification and alignment of quality measures selected for the MetroPlus Member Rewards Program, Provider Pay for Performance Program and Value-Based Programs with the regulatory quality incentive programs driving towards incentive maximization and continued improvement in member health outcomes./liliLeads the QI team’s efforts to identify improvement areas, understand marketplace and member/provider behaviors, research member/provider barriers and validate them within the population, develop predictive models, perform root-cause analysis, and evaluate program effectiveness for quality performance metrics. Synthesizes multiple data streams for clinical and CAHPS metrics to identify high-risk members. /liliIdentify process improvement opportunities and provide guidance and direct oversight to automate processes, implement efficiencies, or execute needed changes./liliMaintain up-to- date knowledge and understanding of HEDIS/QARR/CAHPS measure technical specifications and CMS Star Rating measures, including HOS amp; Operational measures./liliResponsible for regulatory oversight of DOH Performance Improvement Projects and Matrices, the Medicare amp; UltraCare Chronic Care Improvement Project (CCIP) and the Medicare amp; UltraCare Model of Care (MOC), as well as any product line-related audits pertaining to clinical and operational quality metrics. /liliConvene and lead work groups with external vendors and internal staff in support of quality measure improvement. /liliOversee evaluation of the effectiveness of interventions, dashboards, and operational performance indicators to better assess the organization’s ability to meet quality targets. Track and report on initiative progress at all appropriate levels of the organization, including Quality Management Committee and Quality Assurance and Performance Improvement Committee./li/ulMinimum QualificationsulliMaster’s degree in public health, health administration, and/or clinical field. /lili10+ years’ experience in healthcare or managed care industry. 5+ years’ experience in a clinical setting is a plus./liliStrong analytical/quantitative skills. Background in statistics and/or data analysis is a plus. /liliExtensive experience and knowledge with HEDIS/QARR/CAHPS/HOS, CMS Star Ratings./liliProficiency in Microsoft Office (Word, PowerPoint, Excel, Access). /liliClinical license (MD, NP, RN, PharmD, LMSW/LCSW etc.) with 5+ years clinical experience preferred. /li/ulpstrongProfessional Competencies:/strong/pulliTeam Building and Leadership /liliIntegrity and Trust /liliCustomer Focus /liliFunctional/Technical skills /liliWritten/Oral Communication/li/ul