Quality Program Manager - Remote

EmblemHealth; New York (NY); Remote; USD 72,000 - 138,000; Full time

Job summary

An established industry player is seeking a Quality Program Manager to lead quality improvement initiatives that enhance health outcomes for members. This role involves collaborating with various partners, managing quality programs, and ensuring compliance with regulatory standards. The ideal candidate will have extensive experience in quality management, a strong analytical background, and excellent communication skills. If you're passionate about improving healthcare quality and driving impactful projects, this opportunity offers a chance to make a significant difference in the lives of many.

Benefits

Medical Insurance

Vision Insurance

401(k)

Paid Maternity Leave

Paid Paternity Leave

Tuition Assistance

Disability Insurance

Qualifications

• 5-8 years of experience in quality improvement and program management.
• Experience with HEDIS, CAHPS, and quality metrics.

Responsibilities

• Oversee quality improvement projects and action plans.
• Collaborate with cross-functional teams on quality metrics.

Skills

Quality Improvement

Project Management

Data Analysis

Communication Skills

MS Office

HEDIS

CAHPS

CMS Star Ratings

Education

Bachelor's Degree

Certifications in Quality Management

Tools

MS Access

Job description

Direct message the job poster from EmblemHealth

Oversee and actively participate in quality improvement projects. Contribute to the overall success of Quality Programs by promoting /advancing the department mission of effectively managing members and improving health outcomes. Serve as the Quality Management liaison for internal and external partners for projects and improvement initiatives. Subject matter knowledge expert with regards to quality improvement & reporting.

Responsibilities

• Work directly with business partners to plan, implement, and oversee ongoing operational execution of quality improvement projects and action plans (HEDIS, CAPHS, and HOS) to meet corporate business goals for Medicare, Medicaid, QHP, and Commercial product lines.

• Support the execution of centrally developed and data-driven strategic plans.

• Assist in leading cross-functional teams for collaboration on HEDIS, CAHPS, HOS, Pharmacy, and Enterprise metrics.

• Serve as a point of contact for quality vendors: develop and share target lists; provide support in monitoring performance against established Service Level Agreements; provide a communication bridge between the company/line(s) of business and the vendors.

• Manage ongoing quality programs including Member Rewards & Incentives, Provider Quality Incentives, and addressing Health Disparity initiatives.

• Provide subject matter expertise and support on all quality metrics to key stakeholders.

• Support NCQA/CMS/HEDIS/CAHPS/HOS and other regulatory requirements that apply to quality programs.

• Work with the data team to conduct analysis and reporting as needed on initiatives designed to impact quality performance to provide insight to future projects.

• Develop annual performance improvement projects; analyze project data; and ensure completion of the finished product(s) including the development of year-end report(s).

• Develop methodologies for quality program assessment (ROI and proof points of program outcomes, etc.)

Qualifications

• 5 – 8 years of relevant, professional work experience (Required)

• 3 – 5 years of Quality and/or program management experience in a managed care organization (Required)

• Additional years of experience/specialized training/certifications may be considered in lieu of educational requirements (Required)

• Experience in researching, developing, implementing, and assessing results of metrics and analytics (Required)

• Understanding of contractual or compliance related SLAs (Required)

• Ability to successfully manage multiple projects/tasks with competing priority levels and deadlines (Required)

• Experience and knowledge with HEDIS/QARR, CAHPS, CMS Star Ratings, and Accreditation (Required)

• Proficient in MS Office - Word, PowerPoint, Excel, Outlook (Required)

• Excellent communication skills - verbal, written, presentation, interpersonal, active listening (Required)

• Working knowledge of MS Access (Preferred)

Seniority level

• Seniority level

  Mid-Senior level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Quality Assurance, Project Management, and Health Care Provider

• Industries

  Insurance

Referrals increase your chances of interviewing at EmblemHealth by 2x

Inferred from the description for this job

Medical insurance

Vision insurance

401(k)

Paid maternity leave

Paid paternity leave

Tuition assistance

Disability insurance

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