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Job Description:

This position uses informatics and health care industry knowledge to research, interpret and recommend development, modifications, and evaluation of health care improvement programs, strategies, and analysis of health care information, focusing on either member experience/service quality or clinical quality. The Administrator gathers, interprets, and assures follow through on health care improvement data findings and presents such findings and recommendations to appropriate internal audiences, inclusive of Quality Planning Committee, Quality Management Committee, and senior leadership as appropriate in accordance with all appropriate accreditation and regulatory requirements (i.e., BCBSA, CMS, DOH, and NCQA).

In addition, the Administrator e ducates, facilitates, and coaches internal stakeholders on driving culture change and develops effective improvement activities in a highly collaborative manner. The position works to achieve health care improvement outcomes through oversight of such activities, related measurement, and evaluating effectiveness to drive improvements in Health Plan ratings organization-wide. Individual may have matrix reporting relationship with other operational teams.

Essential Responsibilities/Accountabilities:

• Responsible for the design, development, monitoring, and revision of the Health Plan health care improvement program and documentation, including but not limited to the annual evaluation, mid-year assessment, and work plan. In addition, works to achieve the program's goal of improving care and service to members in partnership with other Health Care Improvement Administrators to meet the requirements for the overall program.
• Leads the collection, analysis, and dissemination of data to enable the company to assess the health care environment and forecast trends. Leads research initiatives and collaborates with internal and external stakeholders on projects to assure the Health Care Improvement Program is reflective of the current environment. Acts as subject matter expert for the department.
• Oversees multiple high visibility improvement projects that require coordination with various departments to assure continuous communication and matrix collaboration across related stakeholders, drive broad-scale sustainable improvement, and ensure regulatory requirements are met.
• Oversees development of education and provides necessary coaching to stakeholders in health care improvement methods and measurement analysis.
• Educates, facilitates, and coaches internal stakeholders on the development of effective improvement projects/activities. Develops workgroups and assists in coordination of activities to drive the program goals, including but not limited to developing and modifying existing processes/tools, driving action plans, and generating reports. Coordinates annual health care improvement education for stakeholders across all lines of business.
• Prepares and communicates the results of projects and/or analysis to a variety of audiences using advanced presentation skills.
• Understands HEDIS/QARR and/or CAHPS, HOS and QRS Enrollee Satisfaction requirements and scoring criteria as it relates to health care improvement and NCQA accreditation/DOH regulation and coordinates activities to ensure the standards are met.
• Manages Health Plan-wide projects that require coordination with various departments to ensure the program meets regulatory requirements including National Committee for Quality Assurance (NCQA), Centers for Medicaid and Medicare Services (CMS), and the NYS Department of Health (DOH).
• Assists in the NYSDOH QARR action plan and/or Performance Improvement Projects, as necessary.
• Oversees the program database in developing/maintaining a structured approach to track, monitor, and report program outcomes, as appropriate
• Analyzes health care trends and best practices, and researches their context to determine why they occur, what the literature indicates and relevant constraints, and develops requirements for higher level analytics to support broad-scale sustainable improvement .
• Routinely seeks to understand local/national best practices and evaluates for potential implementation. Develops advanced presentations to communicate impact of program to leadership audiences across the organization, as applicable.
• Identifies and collects health care improvement planning data relevant to program work plan and evaluation. Analyzes and interprets data to improve programs. Works with the Health Analytics, Health System Performance, and other cross-functional teams to identify opportunities for improvement and coordinate and define appropriate interventions to meet organizational planning strategies. Matrix reporting relationship to other HCI teams.
• Supports the Quality Planning Committee, Service Quality Committee and the Quality Management Committee to drive and monitor outcomes and develops and presents reports for Corporate Quality Management Committee (CQMC) as needed. Participates in QM Committees Plan-wide as required.
• Participates in site visits as required for accreditation/regulatory agencies.
• Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies' mission and values and adhering to the Corporate Code of Conduct.
• Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures.
• Regular and reliable attendance is expected and required.
• Performs other functions as assigned by management.

Minimum Qualifications:

• Bachelor's degree required in nursing, health care administration, business administration, or public/community health and with a minimum of five (5) years' experience in the health care field or master's degree with 3 years' experience in the health care field.
• Demonstrated experience in data analysis.
• Strong coaching and facilitation skills to drive measurement ownership and change.
• Must possess strong project management, organizational, planning, and interpersonal skills. Have the ability to work with multiple departments and establish matrix relationships with all levels of internal staff and management.
• Knowledge of basic statistical concepts, quality measurement and improvement tools/techniques and processes, strong analytical and problem-solving skills. Experience in leading performance improvement processes through use of industry accepted modalities, process improvement tools, and techniques (Lean, Six Sigma, PDSA, etc.) preferred.
• Knowledge of health insurance industry, federal and state regulations, accreditation standards, and advancements put forth by quality improvement organizations (including but not limited to NCQA, CMS, The Joint Commission, IHI, AHRQ, NQF, and NYS DOH) preferred.
• Experience using Microsoft Office products required.
• Excellent written and oral communication skills required. Advanced interpersonal and presentation skills.
• Ability to work independently as well as on intra- and inter-departmental teams.
• Must be able to interact with all levels of management .

Physical Requirements:

• Must be able to travel to other Health Plan regions .

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The Lifetime Healthcare Companies aims to attract the best talent from diverse socioeconomic, cultural and experiential backgrounds, to diversify our workforce and best reflect the communities we serve.

Our mission is to foster an environment where diversity and inclusion are explicitly recognized as fundamental parts of our organizational culture. We believe that diversity of thought and background drives innovation which enables us to provide leading-edge healthcare insurance and services. With that mission in mind, we recruit the best candidates from all communities, to diversify and strengthen our workforce.

OUR COMPANY CULTURE:

Employees are united by our Lifetime Way Values & Behaviors that include compassion, pride, excellence, innovation and having fun! We aim to be an employer of choice by valuing workforce diversity, innovative thinking, employee development, and by offering competitive compensation and benefits.

In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position.

Equal Opportunity Employer

Compensation Range(s):

Grade 208: Minimum $67, 538 - Maximum $124, 925

The salary range indicated in this posting represents the minimum and maximum of the salary range for this position. Actual salary will vary depending on factors including, but not limited to, budget available, prior experience, knowledge, skill and education as they relate to the position's minimum qualifications, in addition to internal equity. The posted salary range reflects just one component of our total rewards package. Other components of the total rewards package may include participation in group health and/or dental insurance, retirement plan, wellness program, paid time away from work, and paid holidays.

Please note: There may be opportunity for remote work within all jobs posted by the Excellus Talent Acquisition team. This decision is made on a case-by-case basis.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

Equal Opportunity Employer - minorities/females/veterans/individuals with disabilities/sexual orientation/gender identity

Minimum Salary: 0.00 Maximum Salary: 0.00 Salary Unit: Yearly