Neighborhood Health Plan (NHP), located in Boston, is currently seeking an experienced, highly skilled Manager of Operations Quality Control & Analytics . The Manager, Operations Quality Control and Analytics designs, implements and oversees the Quality Control programs for key Operations processes such as Appeals and Grievances, Claims, Member Enrollment, and the Customer Service Center. This role is also responsible for ensuring the efficient and accurate production of key Operations metrics that enable dynamic decision-making and reliable reporting to internal and external constituents.
The Manager, Operations Quality Control and Analytics is the lead departmental representative in the event of regulatory reporting, internal and external audits, Model Audit Rule (MAR) reporting/analysis, and account-specific performance guarantee reporting/tracking. S/he analyzes customer interactions, identifies critical areas for improvement and drives business transformation. This position uses data, systems, and processes to identify trends, understand movement in key performance indicators, and targets areas that warrant investigation into root cause.
- Collaborate with departmental managers and directors to design, plan, implement and monitor Quality Control programs that provide accurate quality metrics and root/cause analysis for improvement initiatives by quantifying the problem, determining drivers, and understanding the impact in an empirical, quantifiable manner in order to achieve business outcomes
- Under the direction of the Vice President, Operations, and in collaboration with the Operations Leadership Team (OLT), establish, and ensure reliable access to, the key set of departmental metrics that demonstrate how well the department is performing against established organizational and departmental goals and standards. Create and maintain standard reporting formats in support of business goals.
- Continually improve the QC program so that it is efficient and low-cost, while remaining nimble enough to absorb new or revised business processes. This position takes the lead in recommending to IT staff the purchase or building of QC systems for tracking, reporting and synthesis of quality data.
- Ensure documentation of all QC programs is accurate, high quality and scheduled for regular review.
- In collaboration with OLT, lead the design and implementation of a performance program that rewards top performers based on established business goals and measures.
- Ensure control testing and related monthly metrics of NHP’s Model Audit Rule (MAR) are maintained and working properly.
- Provide regular status reporting to management regarding quality control programs.
- Key participant in determining and prioritizing improvement initiatives, and regularly participates in business planning for Operations.
- Provide support, coaching, motivation and guidance to all quality control and reporting analysts.
- Recruit, hire, and develop staff.
- Review performance with direct reports on a regular basis and biannually using the performance management tool. Guide staff through development of goal/action/development plans.
- Foster a positive team environment with open and on-going communication.
- Participate in strategic initiatives and special projects as needed
- Anticipates and meets, or exceeds, internal and/or external customer expectations and requirements; establishes and maintains effective relationships with customers and gains their trust and respect.
- Maintain strong working relationship with IT in order to conduct effective analysis using NHP tools and systems
- Leads the management of vendor extracts on behalf of Operations
- Facilitates the prioritization process of Operations’ IT needs
- BA/BS Degree or equivalent related experience
- 5-7 or more years’ experience in monitoring, measuring and reporting on quality and productivity in a healthcare setting
- 5-7 or more years progressive supervisory experience
- 5 or more years’ experience in health care/HMO operations
- Experience using technical tools that enable easy extraction of data from disparate systems (Above average proficiency in Excel, SQL, Access, etc.)
- Thorough understanding of quality control processes in business operations areas
- Strong statistical analysis skills
- Strong analytical and problem solving skills
- Exceptional communication skills (verbal and written)
- Ability to multi-task and prioritize appropriately
- Able to address employee performance issues directly and provide feedback and direction necessary for development of staff.
- Understanding of healthcare payer operations
- Understanding of how to identify and enhance customer service skills
- Industry Standard Quality Certifications
- Demonstrates NHP Core Values of Service Excellence, Quality Care, Diversity, Responsibility and Relationships.
- Respects the talent and unique contribution of every individual, culture and ethnic group and treats all people in a fair and equitable manner.
NHP offers competitive salaries and an excellent flexible benefits package that includes medical, dental and vision insurance, generous earned time, commuter benefit, and a 401(k) employer contributed retirement program.
NHP’s mission targets a diverse population and our employees are just as diverse. As an equal opportunity employer, NHP recognizes the power of a diverse community and encourages applications from individuals with varied experiences, perspectives, and backgrounds.
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