Medicare Performance Improvement Lead
Company: MetroPlus Health Plan
Location: New York
Posted on: October 19, 2020
Marketing StatementMetroPlus Health Plan provides 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, MetroPlus' network includes over
27,000 primary care providers, specialists and participating
clinics. For more than 30 years, MetroPlus has been committed to
building strong relationships with its members and providers to
enable New Yorkers to live their healthiest life.--Position
Overview--The primary function of the Medicare Performance
Improvement Lead is to provide leadership in developing,
implementing, monitoring and coordinating quality improvement
initiatives that support the goal of improving Medicare Part C
Operational measures. This position will work directly and
collaboratively with all MetroPlus departments, regulatory agencies
and with Provider Groups/Facilities to achieve Plan goals for
improving Medicare Star measure performance. --This position will
serve as the subject matter expert for Medicare Star Operational
- Design, implement and evaluate complex quality and process
improvement projects required to support Star and regulatory needs
to drive specific operation quality improvement outcomes. 70%
- Research, develop and identify internal and external
barriers/root causes that affect that impact poor operational
performance and ensure that implementation of strategies to
overcome these barriers.
- Develop methods and /or tools to collect and track barriers for
targeted process improvement. --Methods may include but not be
limited to surveys, focus groups, observation, work flow analysis,
process mapping, time and motion studies, etc.--
- Create plans/interventions based on barrier, data, and/or
competitor analysis, defined project scope and goals, measurable
metrics for program evaluations, and projected timelines.
- Develop communications that are clear, direct and
- Apply analytics to identify and target various sub processes to
drive quality improvement and measurable outcomes
- Evaluate interventions for project/intervention continuation
and/or modification to provide for continuous process
- Develop tools and supports for external and internal
stakeholders relative to measures/desired outcomes to drive
- Document findings for each initiative and present results to
applicable departments and management.
- Lead and/or participate in external activities, work group or
committees promoting improvement and goals.
- Participate in relevant committees and work groups; make
presentations, prepare reports, data or other materials for
- Implement monitoring processes designed to hold the gains.
--This includes but is not limited to designing training material,
procedures, process control plans, etc. designed to identify
process changes for corrective actions. --
- Analyze organizational data for specified measures to identify
trend and target area for quality improvement projects. --Data
sources and tools may include but not be limited to the following:
- Statistical significant changes in rates/stratifications.
- Data from members, providers, internal processes owners,
vendors, regulatory reports and datasets and internal
- Coordination and implementation of corporate Quality
Improvement initiatives including Chronic Care Improvement Projects
(CCIP) and Quality Improvement Projects (QIP) for Medicare
Advantage, including Special Needs Plans (SNP) and Medicaid
- Track progress, provide project status reports and presents key
metrics and actions plans to the Director of Medicare Stars
- --Effectively manages internal communications by collaborating
and disseminating project activities and outcomes to impacted
- Identify actions required to improve performance and works with
impacted departments to drive implementation and improve
- Complete annual QIP and CCIP templates and/or attestations per
- Support the CCIP and QIP annual CMS submission process to
ensure timeliness and compliance.--
- Actively lead other departments to coordinate and meet measure
improvement needs/goals. --Participate in identification of best
practice benchmarks in relation to operational process measures. --
Align resources utilizing maximum effectiveness and efficiency.
- Develop and maintain positive working business relationships
with community organizations, pharmaceutical vendors, behavioral
health vendors, labs, provider groups, regulatory agencies and
others to promote the continuous improvement of Metro Plus's
operational processes that impact Part C and D Operational Star
- Participate in various Health Educational events. 15%Minimum
- Bachelor's degree in analytical field including Finance, Health
Care Management or related field. --Master's Degree a plus.
- Five to eight years' experience in any analytic field. --Two to
three years of managed care experience preferred.
- Understanding of CAHPS measures and knowledge of HEDIS, QARR,
Star reporting processes strongly preferred
- Knowledge of quality improvement activities such as PDSA
- Must have strong working knowledge of Microsoft Office
applications including Word, Excel, Access and PowerPoint.
- Experience with relational--
- --Ability to lead others on large scale, complex, highly
- Superior working knowledge of MS Office applications.
- Solid analytical skills paired with strong attention to detail.
--Uses rigorous logic and methods to solve difficult problems with
effective solutions. --
- Excellent verbal and written communication skills.
- Knowledge of health care data systems.
- Learns quickly when facing new problems, a relentless and
- Flexible and adaptable in a rapidly changing environment.
- Ability to generate new and unique solutions and makes
connections among previously unrelated notions.
- Dedicated to meeting the expectations and requirements of
internal and external customers
- Creates a climate in which people want to do their best, can
motivate team or project members.
- Ability to shift gears comfortably, can decide and act without
having the total picture.
- Steps up to conflicts, seeing them as opportunities, can find
common ground and get cooperation with minimum noise.
- Ability to figure out the processes necessary to get the job
done, knows what to measure and how to measure it.--Professional
- Integrity and Trust
- Customer Focus
- Functional/Technical skills
- Written/Oral Communication
Keywords: MetroPlus Health Plan, New York , Medicare Performance Improvement Lead, Other , New York, New York
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