Professional, Quality Performance Compliance Manager

Schenectady, NY

Insurance Carriers and Related Activities

About the position

At MVP Health Care, we're on a mission to create a healthier future for everyone - which requires innovative thinking and continuous improvement. To achieve this, we're looking for a Professional, Quality Performance Compliance Manager to join #TeamMVP. This is the opportunity for you if you have a passion for improving quality of care, ensuring compliance and cross-department collaboration this is the opportunity for you.

Responsibilities

• Participates in quality programs and projects to measure, monitor and improve the quality of the care and service provided to members for Medicare, and NY State Government programs.
• Track, monitor and implement programs to assure compliance with all NY and VT State and Federal quality regulations, quality standards and maximize performance.
• Helps to develop, maintain, socialize, and submit of (where applicable) quality improvement department policies and procedures.
• Lead State and Federal quality performance improvement projects (Performance Improvement Projects (PIP) Quality Performance Matrixes (QPMs), Chronic Condition Improvement Project (CCIP), etc.), Quality Improvement Strategy (QIS), and the quality components of HARP and Essential Plan.
• Cross functionally manages quality projects business priorities to achieve quality goals and meet state and federal regulatory requirements.
• Develop and maintain applicable data collection and reporting including submitting reports timely to appropriate parties for review and final submission.
• Regularly monitor regulatory or government policy/methodology updates, changes, and industry news, and assess and address potential impact from changes related to the product line. Incorporate updates as needed to Quality Improvement Program Description.
• Prepare reports and present the activities and analysis to the appropriate agencies such as DOH, DFS, IPRO, or internally to the Quality Committees.
• Create and update Quality Improvement regulatory reports to maintain compliance with relevant federal, state and accreditation regulations and standards.
• Support quality leadership reporting and information needs during plan and public meetings with the regulators (CMS, DOH, DFS, IPRO) when addressing performance and quality improvement projects.
• Contribute to our humble pursuit of excellence by performing various responsibilities that may arise, reflecting our collective goal of enhancing healthcare delivery and being the difference for the customer.

Requirements

• Bachelor's degree in nursing, Social Work, Business Administration, Public Health or Health Sciences or related degree strongly preferred.
• 3 - 5 years' experience in healthcare or managed care industry preferred.
• Medicaid, Medicare and/or Quality Regulatory experience.
• Experience with PIP, CCIPs and Quality Improvement Projects required.
• Quality regulatory experience (QPMs, CMS, NCQA, Medicaid state programs).
• Demonstrated use of PDSA/PDCA.
• Application of Quality Improvement and Quality Management tools to manage and monitor regulatory reports and submissions.
• Curiosity to foster innovation and pave the way for growth.
• Humility to play as a team.
• Commitment to being the difference for our customers in every interaction.

Benefits

• Growth opportunities to uplevel your career.
• A people-centric culture embracing and celebrating diverse perspectives, backgrounds, and experiences within our team.
• Competitive compensation and comprehensive benefits focused on well-being.
• An opportunity to shape the future of health care by joining a team recognized as a Best Place to Work for and one of the Best Companies to Work For in New York.