Santa Clara County Health Plan

Quality Improvement Program Manager

Santa Clara County Health Plan, San Jose, CA, United States

Salary Range: $95,729 - $143,594
The expected pay range is based on many factors, such as experience, education, and the market. The range is subject to change.

FLSA Status: Exempt
Department: Quality Improvement
Reports To: Manager, Quality & Health Education

GENERAL DESCRIPTION OF POSITION
The Quality Improvement Program Manager is responsible for developing and executing a strategy to improve the quality performance for Santa Clara Family Health Plan. This role serves as a critical resource and subject matter expert in supporting, monitoring, managing, and driving strategic projects, interventions, and initiatives for the organization's Medicaid quality improvement program.

This is a highly collaborative role that partners with internal teams across the company, external vendors, and healthcare providers to ensure our programs are achieving our goals. The role uses a variety of data sources to determine performance across current and emerging NCQA Healthcare Effectiveness Data Information Set (HEDIS) & Medi-Cal Accountability Set for Health Care Delivery System (MCAS) measures, identify insights and opportunities for performance improvements, and share these findings with stakeholders to drive continuous improvement. This position reviews and accurately interprets complex regulatory documents, including HEDIS & MCAS measure specifications from CMS and DHCS and measure stewards. This position will lead and present material at internal and external meetings, develop and conduct training on HEDIS & MCAS-related topics, assist in regulatory comment development, help drive goal setting, help prioritize interventions, and develop/implement Quality Improvement Health Equity Transformation Program (QIHETP) related documents and initiatives related quality.

ESSENTIAL DUTIES AND RESPONSIBILITIES
To perform this job successfully, an individual must be able to perform each essential duty listed below satisfactorily.

Implement strategies and initiatives on the HEDIS & MCAS work plan, including managing projects of varying degrees of complexity (i.e., administration of DHCS surveys, Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey, multi-channel member outreach, provider education, off-cycle surveys, and prescription drug event reconciliation).
Independently produce and manage prospective quality reports with analysis to manage program performance, support rating predictions, and support meetings with delegates, provider groups, and internal stakeholders.
Interpret and organize information around current performance, historical trends, predicted performance, and opportunities for improvement (including opportunities relative to competing plans in the market).
Provide comprehensive analysis of measures, barriers, and opportunities, and present results of improvement efforts and ongoing performance measures to management.
Serve as a subject matter expert (SME) on HEDIS & MCAS measures, including the measures that apply to each contract and the organization's strategy for achieving the highest possible rating for each contract, and reviewing regulatory communications and staying abreast of changes to QI program rules, measures, and/or measure specifications
Manage current quality initiatives, collaborate and educate SCFHP staff, provider network and community partners on how to improve SCFHP QIHET Program.
Manage regulatory deliverables, including but not limited to: Population Needs Assessment, Quality Improvement Projects, Performance Improvement Projects, Strengths Weaknesses Opportunities & Threats, Plan Do Study Act.
Implement and support NCQA Accreditation and DHCS Quality & Health Equity activities, including but not limited to: CalAIM, Population Health Management (PHM) initiatives, Health Equity, Social Determinants of Health(SDOH).
Perform other related duties as required or assigned.

REQUIREMENTS - Required (R) Desired (D)
The requirements listed below are representative of the knowledge, skill, and/or ability required or desired.

Bachelor's Degree in Public Health, Healthcare, or a related field, or equivalent experience. (R)
Minimum three years of experience with quality improvement in health related setting, including performing root cause analysis, Plan Do Study Act methodology and monitoring/analyzing improvement, program development. (R)
Knowledge of Medicaid principles and practices with emphasis in quality improvement. (R)
Proven ability to design and execute strategic plans for continuous improvement initiatives. (R)
HEDIS experience. (R)
Medicaid plan or ACOs experience. (D)
Ability to consistently meet accuracy and timeline requirements to maintain regulatory compliance. (R)
Experience leading cross-functional projects. (D)
Maintenance of a valid California driver's license and acceptable driving record, in order to drive to and from offsite meetings or events; or ability to use other means of transportation to attend offsite meetings or events. (R)
Ability to form positive, professional relationships with internal and external stakeholders. (R)
Working knowledge of and the ability to efficiently operate all applicable computer software including computer applications, such as Outlook, Word and Excel. (R)
Ability to use a keyboard with moderate speed and a high level of accuracy. (R)
Proficient in adapting to changing situations, working independently and efficiently alternating focus between tasks to support the operations as dictated by business needs. (R)
Excellent communication skills including the ability to express oneself clearly and concisely when providing service to SCFHP members, providers and external stakeholders over the telephone, in person or in writing. (R)
Ability to think and work effectively under pressure and accurately prioritize and complete tasks within established timeframes.
Ability to assume responsibility and exercise good judgment when making decisions within the scope of the position. (R)
Ability to maintain confidentiality. (R)
Ability to comply with all SCFHP policies and procedures. (R)
Ability to perform the job safely with respect to others, to property, and to individual safety. (R)

WORKING CONDITIONS
Generally, duties are primarily performed in an office environment while sitting or standing at a desk. Incumbents are subject to frequent contact with and interruptions by co-workers, supervisors, and plan members or providers in person, by telephone, and by work-related electronic communications.

PHYSICAL REQUIREMENTS
Incumbents must be able to perform the essential functions of this job, with or without reasonable accommodation:

Mobility Requirements: regular bending at the waist, and reaching overhead, above the shoulders and horizontally, to retrieve and store files and supplies and sit or stand for extended periods of time; (R)
Lifting Requirements: regularly lift and carry files, notebooks, and office supplies that may weigh up to 5 pounds; (R)
Visual Requirements: ability to read information in printed materials and on a computer screen; perform close-up work; clarity of vision is required at 20 inches or less; (R)
Dexterity Requirements: regular use of hands, wrists, and finger movements; ability to perform repetitive motion (keyboard); writing (note-taking); ability to operate a computer keyboard and other office equipment (R)
Hearing/Talking Requirements: ability to hear normal speech, hear and talk to exchange information in person and on telephone; (R)
Reasoning Requirements: ability to think and work effectively under pressure; ability to effectively serve customers; decision making, maintain a concentrated level of attention to information communicated in person and by telephone throughout a typical workday; attention to detail. (R)

ENVIRONMENTAL CONDITIONS
General office conditions. May be exposed to moderate noise levels.

EOE