The Quality Optimization Manager provides subject matter expertise in the collection and interpretation of business requirements for Quality Module development, implementation, and enhancement; In addition, the Quality Optimization Manager will serve a key resource for the client implementation management teams for all Quality and Outcomes modules, assuring accurate and optimal business requirements are gathered, clients and internal teams are supported throughout implementation, and client issues are managed efficiently within production.
- Ensure internal and external outcomes measures, both regulatory and client customized, remain current and compliant.
- Maintain subject matter expertise on Value Based Purchasing strategies coming from the Affordable Care Act and other regulatory bodies.
- Maintain current subject matter expertise in all relevant regulatory requirements including CMS (Center for Medicare and Medicaid), NCQA (National Committee for Quality Assurance), URAC (Utilization Review Accreditation Commission), and any other relevant State or Federal Regulations impacting potential and current clients.
- Identify requirements and timelines associated with The Affordable Care Act that impact Quality and Population Health Modules and assure timely and ongoing associated competency within the software .
- Educate and communicate both verbally and in writing any new or changed federal, state, or client specific quality regulations to the leadership and/or impacted staff, as well as current and potential clients.
- Act as point of contact/subject matter expert for active clients throughout HEDIS season and for Care Gap, P4P and STARS support. Will be responsible for day to day management of staff as organization grows
- 25% travel by plane, automobile or train required occasionally with short notice.
Education, Training, and Experience
- 3-5 years Experience in managed care or physician practice/integrated health system Quality Management environment
- RN Preferred; Bachelor’s Degree Preferred; Associates Degree considered with relevant experience
- Strong analytical skills
- Direct Customer facing experience
- Physician Performance monitoring experience preferred, Risk sharing or Value Based Purchasing Experience required
- Presentation experience
- Demonstrated proficiency in computer skills to include Word, Power Point and Excel
- Management Experience
- Managed care experience (HEDIS, NCQA or URAC, STARS, or other Quality Management experience preferred)
- Experience identifying key metrics and crosswalking regulatory requirements
- Excellent interpersonal and communication skills (written and oral).
- Strong organization and prioritization skills with ability to handle multiple tasks
- Results oriented
- Exhibits honesty and integrity
- Self-motivated, Self-directed
- Critical thinker
- Analytical skills
- Tact and positive demeanor
- Dedication to a high degree of customer service
- Conflict resolution/ problem solving skills
- Team player/team builder/coach