American Health Network Quality Manager in Indianapolis, Indiana

SUMMARY

The Quality Manager is responsible for driving consistency in program implementation designed to facilitate a minimum of a 4 Star quality rating as well as key performance metrics per our Accountable Care Organizations, pay-for-performance health plans, and clinically integrated networks. Theresponsibilitiesof thispositiondemandawiderangeofcapabilitiesincluding:strategicplanning and analysis skills; strong understanding of HEDIS and coding; management breadth to direct and motivate; highly developed communication skills; and the ability to develop clear action plans and drive process, given often ambiguous issues with numerous interdependencies. This position must demonstrate a high level of commitment to improving the operations of AHN’s Population Health Initiatives across the entire organization.

ESSENTIAL FUNCTIONS AND RESPONSIBILITIES

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

ADMINISTRATIVE FUNCTIONS

  • Manages Quality Coordinators, Clinical Quality Consultants (CQC) I, II and Senior CQC and is responsible for the overall success of the market’s performance metrics and HEDIS/Star results.

  • Responsible for all aspects of staff development to include hiring, training, coaching and development.

  • Maximizes staff performance and technical expertise through clearly defined objectives, training, skill development and leadership to ensure quality services to all customers.

  • Delegate, monitor and control work progress on key HEDIS/Star metrics, initiatives/action plans, staff productivity, and administrative expenses.

  • Participates in development and implementation of systems and processes that support quality operations.

  • Maintains effective cross functional services by working effectively with the Medical Director, Population Health Management Team, and other corporate departments.

  • Handles complex and/or difficult provider inquires and/or problems and facilitates resolution of provider/practice issues. Continuously strive to ensure that favorable relationships are maintained while ensuring the interest of the organization.

  • Takes ownership of total work process and provides constructive information to ensure physician partners have support to meet initiatives.

  • Analyzes data while collaborating and/or participating in discussions with colleagues and business partners to identifypotential root causeofissues

  • Demonstrate understanding of providers' goals and strategies in order to facilitate the analysis and resolution of their issues

  • Work with relevant internal stakeholders to identify obstacles and barriers identified by providers, and methods for removing them

  • Communicate industry and company information to providers through various means (e.g., newsletters; emails; outreach calls; teleconference; conferences; on-site meetings)

  • Develops and coaches staff to facilitate strategic business meetings with physician groups and their staff.

  • Guides, oversees and ensures competency of the Quality staff.

  • Assist corporate and local education team and provides input on tools used to education quality staff and other local provider support staff.

  • Ensures all education objectives are being met, both on a formal and ad-hoc basis.

OTHER FUNCTIONS

  • Attends meetings and participates on committees as requested.

  • Reviews current literature and attends training sessions and seminars to keep informed of new developments in the field.

  • Understands and models AHN mission and UHG’s culture standards during all workplace interactions.

  • Performs other related duties and responsibilities as directed.

  • Participates and collaborates with other members of the Population Health Team, Operations and AHN offices during Population Health initiatives, to better care for and meet the needs of our AHN patients.

EDUCATION AND/OR EXPERIENCE

To perform this job successfully, an individual must have the following education and/or experience. Minimum Required Education, Experience & Skills:

  • Bachelor’s degree in Nursing, Ancillary Health Care, Health Care Administration, Business Administration, Public Administration, or a related field required. (Associate Degree with a 4 additional years of comparable work experience beyond the required years of experience may be substituted in lieu of a bachelor’s degree).

  • Five or more years of related experience in Quality/HEDIS/CMS Stars, and ICD10/CPT/CPT II coding knowledge, Provider Relations

  • 2-3 years’ supervisory experience.

  • Strong working knowledge of Medicare quality operations including HEDIS, Stars, Coding and Medicare Advantage.

  • Knowledge of state and federal laws relating to Medicare

  • Ability and willingness to travel, both locally and non-locally, as determined by business need.

  • Exceptional analytical and data representation expertise

  • Advanced Microsoft Office skills. Must be proficient in Excel

Preferred Education, Experience & Skills:

  • Master’s degree in Healthcare Administration, Business Administration, or a related field required. Strong knowledge base of clinical standards of care, preventative health and STAR measures

  • Project Management experience

  • Strong financial analytical background within Medicare Advantage plans (Risk Adjustment/STARS Calculation models)