Manager - Performance Improvement, Albuquerque, NM
Position Type Full-Time
Requisition ID 2019-9898
# of Openings 1
Location : Location US-NM-Albuquerque
Type of Opportunity: Full Time
Work Schedule: Days
The Manager, Performance Improvement has overall responsibility for managing the daily operations of Fluents HEDIS/Star analytics team within the Fluent Performance Improvement Department. This key position works in collaboration with a variety of Fluent entities, departments, administration, and leadership bodies to ensure organizational improvement efforts align with accrediting, licensing, and legal requirements. This position provides leadership for complex analytics and reporting in support of the annual HEDIS submission for Managed Care Organizations (MCOs), Medicare Star Program Ratings, NCQA accreditation, and regulatory and contractual compliance. This position collaborates with the Fluent Director of Performance Improvement to coach, mentor and lead a team of analysts to ensure timely and accurate reporting to meet accreditation and regulatory requirements, and performance measure targets.
STRATEGY & LEADERSHIP
- In collaboration with Fluents Director of Performance Improvement and Senior Leadership, determines an approach to securing and maintaining an annual Medicare Advantage Star Rating of 4.0 or higher, meeting 100% of Medicaid Performance Measure targets as established by New Mexico Human Services Department (HSD) and other States, and ensuring the maintenance of NCQA health plan accreditation for all lines of business.
- Works with Fluents Director of Performance Improvement to provide direction, coordination, implementation, execution, and completion of HEDIS and Medicare Star programs ensuring consistency with accreditation and regulatory requirements; along with company strategy, commitments, and goals.
- Provides leadership and assures continual performance improvement in QA / QI activities while furthering the vision, values and strategies of Fluent and respective MCO customers.
- Promotes Fluents strategies and compliance with policies and standards, adopted accreditation standards and federal / state regulator requirements
ANALYTICS & REPORTING
- Performs highly complex technical analysis and reporting for Fluent, and MCO and delivery system customers.
- Conducts timely analysis of regulatory materials (CMS Call Letters, HEDIS Technical Specifications, HSD contract, etc) for implications on operations related to measure improvement and compliance.
- Minimizes risk levels by assisting with the interpretation, prioritization, development and deployment of work that meets or exceeds contractual requirements, CMS program requirements, and accreditation requirements.
- Assists leaders in identifying opportunities for improvement to address areas of vulnerability related to performance outcomes.
- Manages contractual relationship with NCQA-certified HEDIS vendor and HEDIS auditor.
- Leads search for new NCQA-certified vendors as needed.
- Manages program expectations, frequency and content of status reports to track annual HEDIS milestones and deliverables, and develops best practices and tools for performance measure reporting and management.
- Leads preparations for the annual HEDIS Compliance Audit and serves as the health plan s point of contact during the audit process.
- Oversees data abstraction and medical record review processes (including those conducted by NCQA-certified HEDIS vendor); and identification of critical issues and process improvements to optimize measure results.
- Serves as a subject matter expert on HEDIS measures and the annual HEDIS process, as well as the Medicare Star program and annual rating process for Star and NCQA.
- Identifies, plans for, communicates, monitors and evaluates actions to comply with existing and new regulations, standards and accreditation requirements throughout PDS.
COACHING, MENTORING & RELATIONSHIP BUILDING
- Provides training related to quality performance measures (HEDIS, Medicare Star, Centennial Care) to Fluent and MCOs Senior Leaders, Directors, and staff. Also provides training to community vendor partners to further their understanding of measures and measure improvement opportunities.
- Builds and develops internal collaborative relationships vital to the success of programs. Develops working relationships with external agency representatives and key contacts.
- Negotiates with other department directors/managers to obtain the required information and work group participants from within MCOs.
- Delegates tasks and responsibilities to manage dependencies and critical path resulting in program activities completed on time and within budget.
- Responsible for interviewing, hiring, coaching, and mentoring staff.
- Provides relevant training and education opportunities and performance feedback.
- Responsible for annual performance evaluations for all direct reports* Drafts and submits budget proposals and recommends subsequent budget changes, where necessary.
- Determines the resources and participants needed to achieve goals.
- Performs other functions as required.
Bachelors degree in Business, Healthcare, or related field required. 6 years of additional experience can be substituted in lieu of a degree. Masters degree preferred. Minimum of five years in healthcare/managed care industry with experience in HEDIS/Medicare Star performance measurement, analytics, reporting and forecasting required. Experience presenting to leadership teams, clinicians, and employer groups also required.
- High School Diploma or GED
Benefits are effective day-one (for .45 FTE and above) and include:
- Competitive salaries
- Full medical, dental and vision insurance
- Flexible spending accounts (FSAs)
- Free wellness programs
- Paid time off (PTO)
- Retirement plans, including matching employer contributions
- Continuing education and career development opportunities
- Life insurance and short/long term disability programs,/li>
Presbyterian Healthcare Services is a locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, it is the state's largest private employer with approximately 11,000 employees.
Presbyterian's story is really the story of the remarkable people who have chosen to work here. Starting with Reverend Cooper who began our journey in 1908, the hard work of thousands of physicians, employees, board members, and other volunteers brought Presbyterian from a tiny tuberculosis sanatorium to a statewide healthcare system, serving more than 700,000 New Mexicans.
We are part of New Mexico's history - and committed to its future. That is why we will continue to work just as hard and care just as deeply to serve New Mexico for years to come.
About New Mexico
New Mexico's unique blend of Spanish, Mexican and Native American influences contribute to a culturally rich lifestyle. Add in Albuquerque's International Balloon Fiesta, Los Alamos' nuclear scientists, Roswell's visitors from outer space, and Santa Fe's artists, and you get an eclectic mix of people, places and experiences that make this state great.
Cities in New Mexico are continually ranked among the nation's best places to work and live by Forbes magazine, Kiplinger's Personal Finance, and other corporate and government relocation managers like Worldwide ERC.
New Mexico offers endless recreational opportunities to explore, and enjoy an active lifestyle. Venture off the beaten path, challenge your body in the elements, or open yourself up to the expansive sky. From hiking, golfing and biking to skiing, snowboarding and boating, it's all available among our beautiful wonders of the west.
AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.