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Manager Quality Analytics (Healthcare Effectiveness Data and Information Set)
Job Description
Department(s): Quality Analytics
Reports to: Director II
FLSA status: Exempt
Salary Grade: N – $95,000 – $155,078
Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. The deadline for the first review of applications is on Monday, December 4, 2023 at 11:59 PM. Applicants are encouraged to apply early. Applicants that apply after the first review are not guaranteed to be considered for this recruitment. This recruitment may close at any time without notice after the first review date.
About CalOptima Health
Are you looking for a career that changes lives? As the single largest health plan in Orange County, CalOptima Health serves one in three residents with health insurance programs for low-income children, adults, seniors and people with disabilities. Our 1,500 employees are valued for their individual perspectives and contributions and benefit from flexible work schedules, recognition and opportunities to grow. If you’re looking for a rewarding career supporting a meaningful mission, along with generous benefits and recognition, consider joining us at CalOptima Health!
About the Position
The Manager Case Management provides shared responsibility for the daily operations, activities and projects for the Case Management department. The incumbent works under the general direction of the Director of Case Management and in partnership with the other department managers to provide performance management and development of the case management staff and projects associated with the department to ensure compliance with department policies and procedures, along with the implementation of assigned projects. The incumbent may be required to attend joint operational and community meetings. The incumbent is responsible for monitoring of case management reports and reporting to management or committees.
The Manager Quality Analytics, Healthcare Effectiveness Data and Information Set (HEDIS) will work collaboratively with the Director to develop, implement and evaluate health outcomes and performance measures pertinent to improvement in member care at CalOptima Health. The incumbent will direct the activities of professional staff responsible for the analysis of performance data and its relationship to quality improvement within CalOptima Health’s network of providers. The incumbent will plan and develop performance forecasting by health plan to achieve the highest levels of National Committee for Quality Assurance (NCQA) and Centers for Medicare & Medicaid Services (CMS) health plan ratings. The incumbent will also be responsible for educating the CalOptima Health staff regarding performance measures.
Duties & Responsibilities:
• Cultivates and promotes a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.
• Directs and assists the team in carrying out department responsibilities and collaborates with the leadership team and staff to support short- and long-term goals/priorities for the department.
• Oversees the collection, production and submission of health plan HEDIS and Consumer Assessment of Healthcare Providers and Systems (CAHPS) results for all product lines in accordance with Department of Health Care Services (DHCS), CMS or other regulatory authorities’ requirements.
• Leads and manages the HEDIS team and temporary staff that support HEDIS or other performance measurement deliverables.
• Hires, trains, reviews and sets goals for the team.
• Oversees the production of HEDIS rates for delegated entities.
• Serves as HEDIS subject matter expert and participates in meetings with delegated entities to educate them about their HEDIS scores and opportunities for improvement.
• Leads the coordination with HEDIS vendors and auditors.
• Facilitates the collection of performance measures and reports progress toward goals, including the development of appropriate triggers for determining when a variance from a target warrants further research or quality improvement initiative.
• Provides reports of quality measures in support of medical functions such as HEDIS, clinical registries, disease management, quality improvement and case management.
• Collaborates with the director in departmental budgeting activities.
• Represents Quality Analytics at various committees and meetings.
• Provides consultative services to improvement teams as assigned by the Director and leadership.
• Develops, reviews and revises policies and procedures.
• Educates CalOptima Health staff regarding performance measures.
• Completes other projects and duties as assigned.
Experience & Education:
• Bachelor’s degree required.
• 5 years of experience managing HEDIS operations from inception to final submissions required.
• Experience in a managed health care organization working with NCQA, CMS, Department of Health Care Services (DHCS), Department of Managed Health Care (DMHC) and other quality performance standards, metrics and regulatory requirements required.
• An equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above is also qualifying.
Preferred Qualifications:
• Master’s degree in Public Health, Healthcare, Health Administration or a related field.
Physical Demands and Work Environment:
The physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
• Physical demands: While performing duties of job, employee may be required to move about the organization. Employee must be able to sit for extended periods of time, as well as work at the computer for long periods. Employee is required to use hands and fingers, especially for typing on the computer and using the mouse. Must also be able to reach with hands and arms and must occasionally lift office supply boxes or laptop case, up to 25 pounds. Employee must be able to communicate, particularly for regular phone use, in meetings, face-to-face interaction and while presenting.
• Work Environment: Typical office environment with minimal to moderate noise levels and controlled office temperatures.
About our Benefits & Wellness options:
At CalOptima Health, we know that a healthy and happy workforce is a thriving workforce, which is why we offer a comprehensive benefits package, including participation in the California Public Employees Retirement System (CalPERS), low-cost medical/vision/dental insurance options, and paid time off. To support quality work-life balance, we allow flexible scheduling during core business hours, telework options for some positions, work schedules that allow every other Monday or Friday off (9/80 schedule), and a wellness program featuring diverse activities. Additionally, CalOptima Health contributes 4% of pensionable earnings to a 401(a) retirement program with no required employee contribution. Employees also have access to 457(b) retirement plans with pre/post-tax contribution options.
CalOptima Health is committed to attracting, hiring, and retaining a diverse staff, where we will honor your unique experiences, identity, and perspectives. Our organization strives to create and maintain a workplace environment that is inclusive, equitable and welcoming so we can truly be Better Together.
CalOptima Health is an equal employment opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health wants to have qualified employees in every job position. CalOptima Health prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima Health also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics.
If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability.
Job Location: Orange, California
Position Type:
To apply, visit https://apptrkr.com/4811133
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