Provides data and analytic support, including quality dashboards, outcomes studies, program evaluations, and internal and external reporting. Monitors data trends and identifies patterns, performs modeling, and recommends improvement solutions. Manages HEDIS/QARR data collection and validation, which includes developing extracts to identify HEDIS non-adherence for targeting member/provider outreach. Collaborates with departments that have a direct impact on member satisfaction, clinical service delivery, provider satisfaction and service administration. Works under general direction.
Manages and coordinates data collection, validation, and submission to, including but not limited, HEDIS and QARR.
- Provides support internally in all areas, to include, data, reports, HEDIS/QARR expertise, etc.
- Interfaces internally and externally to facilitate HEDIS reporting processes, which includes data exchange, validation, and software updates.
- Conducts root cause analysis and prepares statistical and quality reports from HEDIS, QARR, and other shared databases to support quality improvement initiatives.
- Establishes data quality specifications and designs. Develops and implements operating standards and procedures to ensure uniformity, integrity in data collection, input and reporting in both automated and manual systems.
- Supports initiatives to improve data quality with providers and operations staff while integrating data needs.
- Assess and documents business requirements, specifications, and methodology.
- Produces Gaps in Care reports for internal staff, Providers, and VBP contracts.
- Analyzes/monitors trends and variances in data and reports. Researches findings and makes recommendations for process and/or operational improvements.
- Prepares detail and summary level reports including written interpretation of analytic results.
- Participates in special projects and performs other related duties as assigned.
For Managed Care Contracting Only:
- Prepares scorecards for Joint Operating Committee’s with Health Plans. Leads reconciliations with Health Plan’s for Value Based Payments.
- Works directly with other departments including but not limited to, Revenue Cycle, Business Intelligence and Analytics, Data Architecture Services, Finance and the clinical teams to verify data.
- Provides information to internal VNSNY teams to support ad-hoc projects and the development of materials that will be shared internally / externally.
Education:Bachelor’s degree in Information Management, Statistics, Healthcare Informatics or related field with equivalent knowledge required. Master’s degree preferred.
Experience: Minimum five years in analytics, and three years Managed Care experience required. Knowledge of Medicare Advantage, Medicaid, MLTC HEDIS/QARR, NYSDOH, NCQA regulations required. Expert proficiency in SQL, Excel and Access required, SAS experience preferred. Strong attention to detail, and effective oral, written and interpersonal communication skills are required. Demonstrated strong qualitative and quantitative analytic skills, as well with the ability to interpret and present key analytic findings required. Demonstrated ability to understand industry issues and problems, relate them to clients’ needs, and propose appropriate solutions required.
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.