Conducts, coordinates and monitors quality activities and initiatives for one or more products of the Health Plan. Maintains, monitors, and develops strategies for the evaluation of member and/or patient care services. Analyzes findings and recommends performance improvement initiatives and/or corrective actions. Identifies performance and process improvement opportunities to improve HEDIS/QARR, Star ratings and Incentive programs, as applicable. Assists management with ensuring compliance with regulatory requirements for all products.
-Develops performance measures, designs data collection instruments, and conducts quality, compliance and utilization reviews.
-Ensures Quality Improvement programs are aligned with CMS Triple Aim framework: improving the patient’s experience of care (including quality and satisfaction), improving the health of populations, and reducing the per capita cost of healthcare.
-Collects and analyzes data, identifies trends, writes reports and presents findings to appropriate committees, managers and/or staff.
-Prepares, coordinates, and participates in QM Committees and subcommittees as directed.
Participates in the coordination, review and approval of policies and procedures for VNSNY CHOICE and its delegated entities. Identifies gaps and recommends creation of new policies.
-Serves as a resource and provides expertise and assistance on quality improvement projects.
-Collaborates with clinical management to identify, develop and implement quality improvement standards and criteria that meet program goals. Evaluates effectiveness of standards and recommends changes, as needed.
-Assists with analysis of member satisfaction surveys and audits including but not limited to the CMS Health Outcomes Survey, Consumer Assessment of Health Care Providers and Systems or internal satisfaction surveys. Collaborates with Health plan staff to develop initiatives and action plans to improve member satisfaction.
-Keeps informed of the latest internal and external issues and trends in utilization and quality management through select committee participation, networking, professional memberships in related organizations, attendance at conferences/seminars and select journal readership.
-Participates in the development and implementation of quality projects and initiatives across all product lines, including but not limited to NCQA HEDIS, NYSDOH QARR, Quality Scorecard, IPRO Projects, and CMS Quality Projects.
Education: Bachelor’s in Healthcare Administration, Public Health, Business or other related healthcare field or the equivalent work experience required. Master’s Degree preferred.
Experience: Minimum of three years quality improvement experience in a health plan or health care, setting required. Demonstrated leadership experience preferred. Excellent oral, written and interpersonal communication skills, including group facilitation skills required. Knowledge of basic Performance Improvement tools and methodologies preferred.
The Visiting Nurse Service of New York (VNSNY) is the nation's largest not-for-profit home- and community-based health care organization, serving the five boroughs of New York City, and Nassau, Suffolk, and Westchester Countries. For over 125 years, VNSNY has been committed to improving the health and well-being of people through high-quality, cost effective healthcare in the home and community. We offer a wide range of services, programs, and health plans to meet the diverse needs of our patients, members, and clients from before birth to the end of life. Each day, more than 13,000 VNSNY employees - including nurses, rehabilitation therapists, social workers, other allied professionals, and paraprofessionals - deliver compassionate care, unparalleled medical expertise, and 24/7 solutions and resources to more than 44,000 patients and members, helping them to live the best lives possible in their homes and communities.