Manager - Quality Care Improvement

Department: Value-Based Care Programs

Employment Type: Full Time

Location: Remote

Reporting To: Tahira Hashmi

Compensation: $105,000 - $130,000 / year

Description

• Put Patients First
• Empower Entrepreneurial Provider and Care Teams
• Operate with Integrity & Excellence
• Be Innovative
• Work As One Team

What You'll Do

• Leadership and oversight over day-to-day operations for designated areas 
• Oversee health plan metrics and ratings including identifying, addressing gaps in performance
• Collaborate with peers within assigned regions and across the organization to deploy effective programs for quality gap closures 
• Lead health plan, IPA and provider meetings to review KPIs, share best practices and design process improvement activities to improve outcomes
• Manage quality data workflows between Astrana and health plans to ensure complete and accurate submission of relevant data
• Support audits requested by payers or other partners to meet compliance requirements • Able to prioritize work to reach overall team goals
• Be detail oriented and show strong organizational skills. 
• Drive outcomes for critical measures assigned to other departments through cross functional teamwork and support
• Able to analyze key trends and succinctly communicate findings to leadership, providers, health plans
• Able to identify barriers or risks early and escalate to leadership for support and intervention
• Manage a team remotely to execute on provider engagement and execution of key initiatives
• Hire, retain, mentor, and manage performance for direct reports through a culture of accountability, collaboration, and continuous improvement.
• Ensure all work completed meets internal compliance requirements as well as health plan and NCQA compliance. 
• Be responsible for assigned health plans including managing ongoing relationships with key individuals, attending meetings, and providing updated presentations among other required tasks. 
• Participate in staff hiring efforts and evaluation of performance during introductory period and annually
• Maintain a professional demeanor at all times with both internal and external stakeholders, including being timely in responses, delivering exceptional customer service, and maintaining clear communication.
• Performance manage direct reports as appropriate and with guidance from HR and department leaders 
• Attend regional meetings in person or remotely depending on business needs
• Able to present to large groups of providers or team members including managing Q/A
• Be a subject matter expert in NCQA guidelines for quality measures and able to direct providers to address gap closures within these parameters.
• Performs other duties, projects and actions assigned in a professional manner, utilizing time and resources efficiently. 

Qualifications

• Minimum of BA/BS degree or equivalent work experience
• Master’s Degree highly preferred
• 5+ years of quality/HEDIS work experience; 2+ years of supervisory/management experience required
• Strong knowledge of value-based programs and managed care operations
• Subject matter expert in NCQA technical specifications or demonstrated ability to access this information
• Excellent oral and writing skills are characterized by the ability to communicate effectively with audiences at all levels
• Excellent analytical critical reasoning and interpersonal communication skills
• Must be ethical and possess the ability to remain impartial and objective
• At least intermediate skills in MS Excel and PowerPoint
• Good organization, critical thinking, and problem-solving skills

Environmental Job Requirements and Working Conditions

• This is a full-time, remote position. Candidates must be able to travel up to 25% of the time to assigned regions and able to travel to corporate offices as needed. The office is located at 1600 Corporate Center Drive in Monterey Park, CA.
• The national target pay range for this position is $105,000 - $130,000 per year. Actual compensation will be based on experience, geographic location (current or future), and other job-related factors.