Vice President of Quality Management

Vice President of Quality Management

Job Ref : 115438

Category : Quality Assurance

Department : QUALITY MANAGEMENT

Location : 50 Water Street, 7th Floor, New York, NY 10004

Job Type : Regular

Employment Type : Full-Time

Hire In Rate : $260,000.00

Salary Range : $260,000.00 - $280,000.00

Empower. Unite. Care.

MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day.

About NYC Health Hospitals

MetroPlusHealth provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health Hospitals, the largest public health system in the United States, MetroPlusHealth network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlus has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.

The Vice President of Quality Management's primary function is to provide strategic and clinical leadership for the Quality Management (QM) Department, including Process & Quality Improvement, Health Promotion, Quality Risk Management, Quality Review Operations (HEDIS / QARR reporting), Consumer Satisfaction Surveillance of the Plan's membership, Medicare Stars, Medicare Health Risk Assessment (HRA) and Model of Care (MOC) Processes and QM Member / Provider Outreach and Education. This position is responsible for oversight of the continued development and direction of the Quality Management Program and annual work plan in accordance with the policies and procedures established by the MetroPlusHealth Board of Directors' Quality Assurance Performance Improvement Committee and the Plan's Quality Management Committee.

Activities for which the Vice President is accountable include HEDIS / QARR reporting, Provider Pay for Performance Programs, MetroPlusHealth Member Rewards Program, Consumer Assessment of Healthcare Providers and Systems (CAHPS) and Health Outcomes (HOS) Surveys, Quality Improvement, including regulatory compliance projects such as the annual QIP, PIPs, CCIPs, NYS Quality Improvement Action Plans, etc. This position is also a key participant in the development of provider VBP arrangements, clinical measure improvement and risk projects to improve risk scoring in various lines of business.

Job Description

• Oversees the development of the Quality Management Program Description, annual work plan and evaluation in conjunction with the Director of QI and the QM Committee.
• Actively participates in the Quality Assurance Performance Improvement Committee of the Board of Directors. Serves as a voting member of the Quality Management Committee, Utilization Management Subcommittee, Behavioral Health Joint Quality and UM Subcommittee, Appeals and Grievance Subcommittee, and Member Advisory Subcommittee.
• Oversees the interaction and reporting processes of the Quality Management Performance Improvement Committee of the Board of Directors and the Quality Management Committee and various MetroPlusHealth QM Subcommittees. Prepares Board and QI Program updates as needed.
• Works with the Plan's analytics department to partner with community based primary care practices to reduce nonusers and appropriate follow up of those with chronic conditions.
• Leads the development and implementation of quality improvement initiatives and interventions and programs to address member needs, member satisfaction (CAHPS), patient

safety concerns and to improve the overall health of members. Leads cross-functionally to ensure QI across the organization.

Minimum Qualifications

Professional Competencies

LI-Hybrid

Salary : $260,000 - $280,000