The Director, Quality Analytics is responsible for the defining strategic direction of the Quality Analytics programs and has direct responsibility for the development, implementation, and evaluation of the HEDIS program. The Director will serve as an internal expert, consultant and resource to support plan goals around improved quality of care, reduced medical and administrative costs, and improved efficiencies.
Principal responsibilities include:
· Plan and implement programs to achieve Alameda Alliance HEDIS annual goals
· Ensure accurate and timely submission of HEDIS results and data to meet all compliance and accreditation requirements.
· Implement Year Round HEDIS program to evaluate HEDIS results and identify programmatic weaknesses and performance gaps.
· Develop strategy to optimize data procurement and quality, member and provider engagement, and delegate specific strategies to improve rates.
· Lead the design and implementation of initiatives to meet Alliance goals and align with provider network needs. This includes but is not limited improving access and availability of network services and provider quality payment programs.
· Lead analytic initiatives to track utilization of appropriate services and utilize predictive modeling to drive population health programs.
· Maintains procedures and instructions for self-assessment, performance monitoring and improvement programs as needed.
· Facilitates senior management oversight through periodic reviews and reporting of key performance indicators.
· Develops comprehensive approach to achieve internal and external standards for quality and reliability including data management and outcomes reporting
· Writes work plans, evaluations, reports, policies & procedures, workflows and other documents as required
· Performs other duties and special projects as assigned.
ESSENTIAL FUNCTIONS OF THE JOB
· Data collection, measurement, maintenance, and analysis.
· Report and presentation development to support regulatory/compliance submissions.
· Expert resource with business leadership, IT, employees and outside consultants, vendors, agencies, and network on behalf of the company.
· Coordinate and consult with Alliance departments on performance and analytics activities and projects.
· Hire, coach and develop staff to accomplish organizational objectives. Ensure appropriate direction, allocation, motivation and evaluation of their work.
· Leading and participating in internal and external committees and meetings.
· Keep abreast of healthcare industry best practices and managed care regulatory requirements.
· Comply with the organization’s Code of Conduct, all regulatory and contractual requirements, organizational policies, procedures, and internal controls.
· Constant and close visual work at desk or computer.
· Constant sitting and working at desk.
· Constant data entry using keyboard and/or mouse.
· Frequent use of telephone headset.
· Frequent verbal and written communication with staff and other business associates by telephone, correspondence, or in person.
· Frequent lifting of folders and various other objects weighing between 0 and 30 lbs.
· Frequent walking and standing.
· Occasional driving of automobiles.
EDUCATION OR TRAINING EQUIVALENT TO:
· Bachelor’s degree in health related, scientific, or public policy/business discipline or equivalent experience.
MINIMUM YEARS OF ADDITIONAL RELATED EXPERIENCE:
· Seven years of experience in data systems and or/analytics in a managed care, or similar setting required.
· Five years management and/or supervisory experience required.
· Exceptional experience leading quality programs.
SPECIAL QUALIFICATIONS (SKILLS, ABILITIES, LICENSE):
· Proficient experience with Access, Excel, Power Point, HSD Diamond, SQL, SQL Server Management Studio, and other business intelligence tools preferred.
· Ability to work collaboratively with physicians, staff and external organizations to improve quality outcomes.
· Experience leading and coordinating successful internal strategic planning efforts and implementing continuous quality improvement processes and programs
· Ability to lead and train staff in various quality improvement and performance improvement methodologies.
· Strong communication and presentation skills, training/meeting facilitation skills a plus.
· Solid relationship building and interpersonal skills.
· Excellent writing, research, analytical, and time management skills.
· Excellent coordination skills, including multi-tasking and setting priorities on work assignments.
· Ability to organize and coordinate various activities involved in a research, collaborative and demonstration project.
· High degree of independence, flexibility, initiative and commitment.
· Ability to work effectively with diverse population, both internally and externally.
· Solid critical thinking and problem-solving skills.
· Ability to utilize sound judgment and promptly report potential risks.
· Ability to work in a fast paced, patient-service oriented environment.
· Demonstrate ability to promote quality improvement through development and maintenance of standards.
· Must handle PHI and maintain confidentiality at all levels.
$110,000 - $177,290/annually