Manager, Medicaid ACO Performance Programs
Steward Health Care Network (SHCN) takes pride in its community-based care model, which drives value-added tools and services to our communities, patients, physicians, and hospitals across the continuum of care. In addition, Steward Health Care Network promotes care coordination and collaboration within the network in order to provide high-quality, efficient care to patients. With Steward in the community, all residents can be sure that there is a world-class doctor close to where they live.
The network is also responsible for the implementation and execution of our managed care contracts, medical management services, quality improvement programs, data analysis, and information services.
Position Purpose: Under the direction of the National Senior Director for Government Quality Programs, the Manager, Medicaid ACO Performance Programs oversees all aspects of performance initiatives, vendor management, and project planning for the Medicaid ACO. This role will lead key business initiatives aimed at ensuring operational efficiencies, meeting budgeted and contractual performance targets, and coordinating between cross functional business partners (e.g., Care Management, Pharmacy and Medicaid business unit) to drive quality performance outcomes for the Medicaid ACO. The role will assume a variety of tasks including, but not limited to, developing, and executing project and implementation plans, reporting on progress towards key business objectives, continuous QI/PI research and reporting, and vendor management.
- Develops and maintains Performance Programs strategic plan for the Medicaid ACO, ensuring that strategies are made with consideration of quality improvement, utilization management, care retention, and are developed using internal performance data, industry standards, and published literature
- Responsible for planning, coordinating, implementing, and overseeing strategies and tactics to support Performance Operations team with the goal of improving quality and financial performance. Provides project management support to QM, which may include creating and monitoring tracking mechanisms and monitoring improvement initiatives
- Oversees implementation and management of Performance Operations vendors and associated contracts for the Medicaid ACO. Ensures compliance of vendor obligations and optimizes use of vendor services and capabilities by Performance Operations team members
- Develops and maintains Performance Programs dashboard to identify opportunities for improvement, growth, and continued success, using competitive intelligence and industry research as applicable. Using data, evidence-based techniques, and business (contractual) priorities, identify top opportunities to improve performance measure rates and communicate these in a clear and timely fashion to leadership
- Creates plans, systems, and methods to support integration of new opportunities into the department’s workflow
- Oversees Medicaid ACO quality measurement, reporting and audits, including HEDIS, CAHPS, and custom state measures. Through data and analysis, evaluates impact of performance programs, and uses results to identify improvement and enhancement opportunities
- Project manages all aspects of collection of hybrid performance measure data and submission of this data to regulatory bodies in an accurate, complete, and timely fashion. Identify and implement opportunities to collect this data year round
- Manages quality improvement audit cycle, including project plans, training curriculum, and quality control of auditor’s work
Education / Experience / Other Requirements
- Bachelor's degree required
- Master’s Degree preferred
Years of Experience:
- Four (4) + years of experience in health care quality focused roles that included medical record audits and/or performance metric i.e., HEDIS, Stars, or similar
- Significant experience in quality measurement, HEDIS, interpretation of claims data, medical record review
- Strong computer skills, i.e., using various software, including intermediate Excel skills (sort, filter, reformat data, etc.)
- Strong analytic skills/ability to translate complicated data into useable information, including analysis of practice variation
- Successful experience managing complex projects beginning to end with accountability for outcomes, demonstrated organizational and project management skills to manage complex projects through effective planning, tracking, and resource allocation to meet business objectives and timelines
- Strong leadership and management skills; self-directed Ability to generate creative solutions
Steward Health Care is an Equal Employment Opportunity (EEO) employer. Steward Health Care does not discriminate on the grounds of race, color, religion, sex, national origin, age, disability, veteran status, sexual orientation, gender identity and/or expression or any other non-job-related characteristic.
Steward Health Care Network is taking additional, necessary preparations to ensure patients can receive compassionate care in a safe, carefully managed environment – with confidence and without fear.
Our Safe and Ready program consists of a rigorous [three-point] standard ensuring patient safety, confidence and convenience:
- Any COVID-19 related care takes place in designated areas away from other patients and their families.
- A stringent cleaning policy has been implemented throughout our facilities.
- A strictly controlled visitor and masking policy is required for patient and colleague safety.
You can rest assured that we have made the necessary preparations to provide care in a safe, controlled and professional way.