Program Manager, Quality

Program Manager, Quality

Job Summary

ArchWell Health's Quality Program Manager, reporting to the Director, Quality STARS, will be an integral part of the central services team. The Quality Program Manager is responsible for the development, implementation, monitoring and reporting of CMS STARS HEDIS measures, overseeing the central patient outreach calls, and partnering with payers for strategy and data sharing. This role with interface with health plans, IT data engineering, vendors, and patient care teams. This role will provide leadership to the central quality analyst team and clinical education activities at ArchWell Health that improve value-based care over multiple markets and states in an outpatient senior-focused primary care setting.

Essential Duties/Responsibilities

• Monitor CMS STARS HEDIS performance of ArchWell Health over multiple health plans and states
• Hiring and leadership to the Quality Outreach team and acts as subject matter expert
• Helps to design and implement enterprise and local strategies and initiatives for closing HEDIS gaps
• Provides education and guidance to the market based Quality Coordinators supported by the central Quality Outreach team
• Develop, maintain, and deploy a standardized onboarding program for the Outreach Team
• Meet regularly with health plan representatives
• Assists in developing provider education on Quality topics as assigned
• Build relationships and collaborate with IT data team, Pharmacy team, and market leadership.
• Submit supplemental data to Health Plans on a regular cadence
• Additional responsibilities and duties as requested and deemed necessary by the Director, Quality STARS

Required Education and Experience:

• Associate degree or equivalent preferred
• Minimum of 2 years' experience with Quality, HEDIS, CMS STAR program

Knowledge, Skills, and Abilities:

• Experience with Electronic Medical Records
• Advanced knowledge of NCQA Technical Specifications
• Working knowledge of ICD-10, CPT, and HCPCS codes
• Proficient with Microsoft Office Suite products including Word, Excel, Power Point, and Outlook, and Teams
• Ability to travel to visit centers to provide clinical education.
• Demonstrated strong leadership and team building skills
• Experience in clinical process improvement
• Excellent presentation, verbal, and written communication skills
• Ability to exercise use of independent judgement
• Sensitivity to the diverse needs of culturally diverse staff, patients, and communities
• Experience in development and maintenance of guidelines and clinical policies
• Embodies and serves as a role model of ArchWell Health's Values:

• Be compassionate
• Strive for excellence
• Earn trust
• Show respect
• Stay resilient
• Always do the right thing

ArchWell Health is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to their race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other protected classification.