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Careers

CHILDREN’S HEALTH HOME OF UPSTATE NEW YORK
 (CHHUNY)
 POSITION DESCRIPTION
 
POSITION TITLE:                QUALITY PROGRAM MANAGER
 
REPORTS TO:                       CHHUNY CEO
 
DATE:                                     7/25/2018
 
POSITION DESCRIPTION:  Full-Time
 
PURPOSE:
 
CHHUNY is seeking a competent Quality Program Manager who will direct the organization’s efforts in Quality Assurance, Continuous Performance Improvement, and Care Management Training initiatives as related to the quality of services provided and achieving desired outcomes.
 
RESPONSIBILITIES:

  • Develop and implement a Quality Management Program addressing areas including but not limited to; chart audit process, gaps in care, utilization management, documentation compliance, NYS Health Home Performance Metrics, Medicaid Managed Care Plan expectations, and more
  • Promotes quality in clinical practice by collaborating in the development of policy and procedures
  • Oversee Medicaid Managed Care Plan’s outcome expectations and alignment of care management activities with HEDIS, QARR, and other measures as defined by the Managed Care Plan in preparation for value-based payment models
  • Collaborate with Medicaid Managed Care Plans as it relates to CHHUNY’s quality management program
  • Work with network providers to drive care management improvement while educating on measures, performance, and the CHHUNY care management model
  • Lead the CHHUNY Clinical Quality Workgroup
  • Develop key performance indicators to identify gaps and successes with network providers
  • Participate on case reviews as needed
  • Identify training needs and secure subject matter experts to provide trainings to network providers
  • Provide direction and oversight to business associates performing quality tasks on behalf of CHHUNY
  • Analyze data and report information to identify the need for change, minimize risk, and ensure effectiveness of quality improvement
  • Notify organization Compliance Officer of any risk areas as it relates to quality of services and Medicaid reimbursement
  • Design a reporting structure to inform CEO of network provider performance
  • Assists in development and implementation of any performance improvement plans required by governing bodies or managed care plans
  • Work closely with state agency partners to ensure CHHUNY is addressing all stakeholder expectations as it relates to quality of care management services
QUALIFICATIONS:
 
  • Bachelor’s degree in relevant field, Master’s degree preferred
  • Registered Nurse or Licensed Clinician preferred
  • Minimum of 5 years’ experience in a health care organization
  • Must have experience working within a children’s setting of care
  • Experience working with Medicaid Managed Care
  • Familiarity of HEDIS and QARR measures
  • General understanding of value-based payment models
 
OTHER QUALIFICATIONS:
  • Demonstrates a high degree of leadership, motivation, self-direction, and initiative in quality management activities
  • Experience with health information technology and reporting tools
  • Analytical and process-oriented
  • Innovative, entrepreneurial 
  • Date-driven
 
 

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