General Summary of Position
Responsible for implementation, integration and operational direction of the quality improvement program within MedStar Family Choice's (MSFT) Maryland Medicaid operations through organizing and directing the activities of Quality Improvement Services, this includes, but is not limited to, monitoring MFC participating provider processes and outcomes, overseeing the preparation and response for the EQRO and HEDIS audits, acting as the liaison between QI and other departments, and assisting the Medical Director with any State reports and meetings. Will be responsible for developing and executing innovative strategies to ensure VBP(value-based purchasing) targets are met, CAHPS results are above the HealthChoice aggregate, and Maryland Consumer Report Card results are above the HealthChoice average. Will work collaboratively with NCQA Accreditation Project Manager to ensure all standards are met. Oversees MedStar Family Choice's Quality Improvement Program (QIP), completion of the annual assessment of the QIP against external regulations, and MFC's annual operating plan to ensure MFC is in alignment with meeting regulatory requirements and internal goals. Analyzes outcome data to direct activities of Quality Improvement. Oversees MFC's participating provider processes and outcomes, overseeing the preparation and response for the EQRO (external quality review organization) and HEDIS audits, acting as the liaison between QI and other departments, coordination with the Medical Director on reports and meetings for the regulatory agency, and assisting the NCQA project Manager to ensure MFC maintains NCQA accreditation. Oversees and develops departmental goals and ensure alignment with external regulatory requirements and MFC's annual operating plan. Analyzes outcome data to direct outreach activities to achieve all regulatory targets and HEDIS benchmarks within the 75th - 90th percentile. Aligns wellness initiatives with the goals and standards of the local jurisdiction to include Value Based Purchasing, EPSDT and HEDIS standards.
Primary Duties and Responsibilities
Develops department goals, objectives, policies, and procedures. Ensures compliance with business unit policies and procedures and governmental and accreditation regulations.Develops and recommends department operating budget and manages resources according to approved budget.Selects, trains, orients, and assigns department staff. Develops standards of performance, evaluates performance, and conducts performance management planning. Initiates or makes recommendations for personnel actions. Maintains ongoing communication with subordinates to review programs, provide feedback, discuss new developments, and exchange information.Actively participates with annual strategic planning objectives for MedStar Family Choice. Initiates innovative ideas and programs to improve quality while maintaining or reducing medical expense.Oversees the department operating budget and ensures that the department operates within budget. Oversees the development of the annual MFC QI plan, QI appraisal, and the preparation of the annual MFC Health Education Plan and Health Education appraisal.Oversees and supervises annual quality audits performed by the external quality review organization (EQRO) and NCOA such as: CAHPS, HEDIS, EPSDT, Encounter data Validation, Network Adequacy Validation, and System Performance Review. Responsible for ensuring that the Quality Improvement department is adhering to NCQA guidelines. Conducts periodic audits to evaluated adherence.Identifies issues within the network of providers and vendors related to wellness compliance and quality improvement initiatives. Works with the appropriate departments to correct issues as they arise.Prepares, analyzes, and oversees special reports such as CAHPS, EPSDT, Provider Satisfaction, Annual Technical Report, SPR, Performance Improvement Projects (PIP's), Value Based Purchasing (VBP), and Encounter Data Validation.Works collaboratively with the Manager of Outreach to assist with the development of annual strategies to improve member compliance and HEDIS scores. Oversees reports on progress regularly and changes strategies as needed when goals are not being met.Provides ongoing individual coaching and support to staff and acts as a resource for clinical, social issues related to the department objectives. Meets regularly with department members to enhance communication and facilitate implementation and progress towards program objectives. Assists staff members to set personal and educational goals and objectives to enhance their professional development.Responsible to coordinate and conduct studies for the various quality measures required by State regulatory guidelines and NCQA. Evaluates member satisfaction and provider satisfaction, makes modification as necessary to improve satisfaction.Supervises and monitors the effectiveness of contracted vendors who assist with outreach, wellness, member service, and quality efforts. Oversees the development of a Corrective Action Plan when goals are not met.Works collaboratively with the Information Systems Team and the Senior Data Analyst to develop reports to mee the department's annual objectives. Uses technology to enhance decision making and effectiveness.Oversees the development, preparation, and delivery of meaningful real time Provider Scorecards to MFC's participating providers to educate, inform, and assist them to obtaining MFC's goals and objectives. Oversees and assists with MedStar Medical Group's Quarterly POD Meetings to deliver Provider Scorecards and perform face to face provider education on MFC's QI Program.Collaborates with the Manager of Outreach with the development, implementation, and revision of wellness and preventative care programs, goals and interventions. Ensures that each area meets targeted goals as determine by the regulatory jurisdiction such as Value Base purchasing (VBP), EPSDT, and HEDIS. The goal is at minimum neutral to incentive targets and/or NCQA 75th to 90th percentile.Assists staff members with setting personal and educational goals and objectives to enhance their professional development. Develops and implements education programs to coordinate staff development and training needs both for software and clinical training issues.Assists with organizing the agenda and actively participates in QI/UM Committee meetings, other departmental meetings, and State meetings as directed. Oversees the preparation and distribution of agendas and minutes for committee meetings.Provides first line response to quality issues. Follows the established protocol for reporting any quality issues identified.Participates in meetings and on committees and represents the department and business unit in community outreach efforts.Participates in multidisciplinary quality and service improvement teams and maintains effective working relationships with other departments. Performs other duties as assigned.
Minimum Qualifications
Education- Bachelor's degree in healthcare field required and
- BSN preferred and
- Master's degree in healthcare field preferred and
- CPHQ certification preferred
Experience- 3-4 years Quality improvement experience in an outpatient setting and preferable within a Managed Care Organization (MCO), 3 years supervisory experience system development and implementation experience. required and
- 3-4 years supervisory experience; system development and implementation experience required and
- 5-7 years diverse clinical experience required
Licenses and Certifications- RN - Registered Nurse - State Licensure and/or Compact State Licensure Valid RN license in the local area serving (State of Maryland or District of Columbia) Upon Hire preferred or
- certification in healthcare related field Upon Hire preferred and
- CPHQ - Certified Professional in Healthcare Quality Upon Hire preferred
Knowledge, Skills, and Abilities- Knowledge of current trends in health care delivery and population management.
- Knowledge of NCQA, HEDIS, EQRO audits and local regulatory guidelines.
- Strong analytical skills, technical writing skills, excellent problem-solving skills and ability to exercise independent judgement.
- Business acumen and leadership skills.
- Strong verbal and written communication skills with ability to effectively interact with all levels of management, internal departments and external agencies.
- Proficient with Microsoft Office applications especially Outlook, Word, Excel and PowerPoint.
- Proficiency with Microsoft Teams and other virtual meeting platforms preferred.
- Ability to enter and retrieve information using a PC.
- Working knowledge of various computer software applications.
Why MedStar Health?
At MedStar Health, we understand that our ability to treat others well begins with how we treat each other. We work hard to foster an inclusive and positive environment where our associates feel valued, connected, and empowered. We live up to this promise through:
- Strong emphasis on teamwork - our associates feel connected to each other and our mission as an organization. In return, our effective team environment generates positive patient outcomes and high associate satisfaction ratings that exceed the national benchmark.
- Strategic focus on equity, inclusion, & diversity - we are committed to equity for all people and communities. We continue to build a diverse and inclusive workplace where people feel a sense of belonging and the ability to contribute to equitable care delivery and improved community health outcomes at all levels of the organization.
- Comprehensive total rewards package - including competitive pay, generous paid time off, great health and wellness benefits, retirement savings, education assistance, and so much more.
- More career opportunities closer to home - as the largest healthcare provider in the Baltimore-Washington, D.C. region, there are countless opportunities to grow your career and fulfill your aspirations.
About MedStar Health
MedStar Health is dedicated to providing the highest quality care for people in Maryland and the Washington, D.C., region, while advancing the practice of medicine through education, innovation, and research. Our team of 32,000 includes physicians, nurses, residents, fellows, and many other clinical and non-clinical associates working in a variety of settings across our health system, including 10 hospitals and more than 300 community-based locations, the largest home health provider in the region, and highly respected institutes dedicated to research and innovation. As the medical education and clinical partner of Georgetown University for more than 20 years, MedStar Health is dedicated not only to teaching the next generation of doctors, but also to the continuing education, professional development, and personal fulfillment of our whole team. Together, we use the best of our minds and the best of our hearts to serve our patients, those who care for them, and our communities. It's how we treat people.
MedStar Health is an Equal Opportunity (EO) Employer and assures equal opportunity for all applicants and employees. We hire people to work in different locations, and we comply with the federal, state and local laws governing each of those locations. MedStar Health makes all decisions regarding employment, including for example, hiring, transfer, promotion, compensation, benefit eligibility, discipline, and discharge without regard to any protected status, including race, color, creed, religion, national origin, citizenship status, sex, age, disability, veteran status, marital status, sexual orientation, gender identity or expression, political affiliations, or any other characteristic protected by federal, state or local EO laws. If you receive an offer of employment, it is MedStar Health's policy to hire its employees on an at-will basis, which means you or MedStar Health may terminate this relationship at any time, for any reason.
