Company Statement
EmblemHealth is one of the nation’s largest not for profit health insurers, serving members across New York’s diverse communities with a full range of commercial and government-sponsored health plans for employers, individuals, and families. With a commitment to value-based care, EmblemHealth partners with top hospitals and doctors, including its own AdvantageCare Physicians, to deliver quality, affordable, convenient care. At over a dozen EmblemHealth Neighborhood Care locations, members and non-members alike have access to community-based health and wellness guidance and resources. For more information, visit emblemhealth.com.
Quality Programs Manager
Summary of Job
Oversee and actively participate in quality improvement projects. Contribute to the overall success of Quality Programs by promoting /advancing the department mission of effectively managing members and improving health outcomes. Serve as the Quality Management liaison for internal and external partners for projects and improvement initiatives. Subject matter knowledge expert with regards to quality improvement & reporting.
Responsibilities
• Work directly with business partners to plan, implement, and oversee ongoing operational execution of quality improvement projects and action plans (HEDIS, CAPHS, and HOS) to meet corporate business goals for Medicare, Medicaid, QHP, and Commercial product lines.
• Support the execution of centrally developed and data-driven strategic plans.
• Assist in leading cross-functional teams for collaboration on HEDIS, CAHPS, HOS, Pharmacy, and Enterprise metrics.
• Serve as a point of contact for quality vendors: develop and share target lists; provide support in monitoring performance against established Service Level Agreements; provide a communication bridge between the company/line(s) of business and the vendors.
• Manage ongoing quality programs including Member Rewards & Incentives, Provider Quality Incentives, and addressing Health Disparity initiatives.
• Provide subject matter expertise and support on all quality metrics to key stakeholders.
• Support NCQA/CMS/HEDIS/CAHPS/HOS and other regulatory requirements that apply to quality programs.
• Work with the data team to conduct analysis and reporting as needed on initiatives designed to impact quality performance to provide insight to future projects.
• Develop annual performance improvement projects; analyze project data; and ensure completion of the finished product(s) including the development of year-end report(s).
• Develop methodologies for quality program assessment (ROI and proof points of program outcomes, etc.)
Qualifications
• Bachelor’s Degree; Master’s Degree (Strongly Preferred)
• Project Management/Vendor Management certification (Preferred)
• 5 – 8 years of relevant, professional work experience (Required)
• 3 – 5 years of Quality and/or program management experience in a managed care organization (Required)
• Additional years of experience/specialized training/certifications may be considered in lieu of educational requirements (Required)
• Experience in researching, developing, implementing, and assessing results of metrics and analytics (Required)
• Understanding of contractual or compliance related SLAs (Required)
• Ability to successfully manage multiple projects/tasks with competing priority levels and deadlines (Required)
• Experience and knowledge with HEDIS/QARR, CAHPS, CMS Star Ratings, and Accreditation (Required)
• Proficient in MS Office - Word, PowerPoint, Excel, Outlook (Required)
• Excellent communication skills - verbal, written, presentation, interpersonal, active listening (Required)
• Working knowledge of MS Access (Preferred)
Security Disclosure
If you receive a job offer from EmblemHealth, the email will be from “HRTalentAcquisition” with the subject: “Offer of Employment for (job title) – Please respond online.” We will never ask you to join a Google Hangout, buy your own equipment, or pay to apply. We also do not use third-party email services like Yahoo or Gmail.
Pay Disclosure
At EmblemHealth, we prioritize transparency in our compensation practices. We provide a good faith estimate of the salary range for potential hires, which is based on key factors such as role responsibilities, candidate experience, education and training, internal equity, and market conditions. Please be aware that this estimate doesn’t account for geographic differences related to your work location. Typically, new hires may not start at the top of this range, as compensation is tailored to each individual's circumstances. For union positions, salaries will be determined according to the collective bargaining agreement. Join us at EmblemHealth, where your contributions are valued and supported by fair compensation.
EEOC Statement
We value the diverse backgrounds, perspectives, and experiences of our workforce. As an equal opportunity employer, we consider all qualified applicants for employment regardless of race, color, religion, sex, sexual orientation, gender identity, pregnancy, marital status, national origin, disability, veteran status, or any other protected characteristic protected by law.
Sponsorship Statement
EmblemHealth may provide work visa sponsorship depending on factors such as business unit requirements, position nature, costs, and applicable laws and regulations.