Manager, Performance Metrics-Ratings PCHP

Interested in a career with both meaning and growth? Whether your abilities are in direct patient care or one of the many other areas of healthcare administration and support, everyone at Parkland works together to fulfill our mission: the health and well-being of individuals and communities entrusted to our care. By joining Parkland, you become part of a diverse healthcare legacy that's served our community for more than 125 years. Put your skills to work with us, seek opportunities to learn and join a talented team where patient care is more than a job. It's our passion.

Primary Purpose

Responsible for Parkland Community Health Plan's (PCHP) performance metric and rating programs. Accountable for the overall program management and quality-related activities.

Minimum Specifications

Education

• Bachelor's degree in business or healthcare administration, computer science or related discipline required.

Experience

• Five (5) years of experience in healthcare with four (4) years of experience in a managed care organization required.
• Four (4) years of experience with performance metrics or rating programs (HEDIS, Medicare Star Ratings, External Quality Review Organization).
• Prior management experience preferred.

Equivalent Education and/or Experience

• Five (5) years of experience with performance metrics or rating programs in Texas Medicaid, Medicaid, or a Medicaid managed care organization may be considered in lieu of a bachelor's degree.

Certification/Registration/Licensure

• Certified Professional in Healthcare Quality (CPHQ), Project Management Professional (PMP), or Six Sigma certification preferred.

Skills or Special Abilities

• Excellent verbal and written communication skills including the ability to communicate effectively and professionally across disciplines and with a variety of constituents as well as the ability to articulate complex information in understandable terms.
• Demonstrated ability to coach and influence for results.
• Excellent people skills with the ability to establish and maintain effective working relationships with diverse groups across and beyond the organization.
• Strong analytical, project management, and problem-solving skills.
• High level attention to detail.
• Strategic thinking and long-range planning skills with the ability to lead major organizational initiatives, accomplish results, and achieve measurable outcomes or goals.
• Ability to work in challenging situations involving competing interests, and high level-interdisciplinary groups.
• Strong time management skills with the ability to manage multiple demands and respond to rapidly changing priorities in a fast-paced environment.
• In-depth knowledge of performance metric and rating programs such as HEDIS, Medicare Star Ratings, and EQRO.
• Familiarity with Texas Medicaid, National Committee for Quality Assurance (NCQA), the Uniformed Managed Care Contract, and the Uniform Managed Care Manual including reporting requirements and deadlines.
• High proficiency with Microsoft Office and advanced computer skills.

Responsibilities

Performance Metric and Rating Programs

• Manages, plans, and executes performance metric and rating programs assigning and monitoring work while also providing support and direction to staff.
• Review and implement annual NCQA HEDIS technical specifications, value sets, and coding.
• Develop the annual HEDIS work plan in accordance with PCHP guidelines and regulatory requirements.
• Analyze and evaluate HEDIS rates communicating to internal and external stakeholders.
• Assists with developing and maintaining all required annual metrics and quality program documents.
• Works collaboratively with internal and external stakeholders to secure additional clinical data sources and points.
• Trains all HEDIS team staff and delegates HEDIS-related tasks.
• Monitors and tracks key performance indicators, programs, and initiatives to reflect programmatic value and effectiveness.

Auditing, Data Analysis, and Reporting

• Leads the annual audit and activities related to the HEDIS roadmap.
• Responsible for data analysis, ad-hoc, and regulatory reporting required by the organization related to the HEDIS population.
• Coordinates and supervises the comprehensive aspects of the hybrid medical record review in conjunction with the Clinical Quality Manager.
• Verifies that data are submitted to external agencies within required time frames.
• Oversee ETL and QC of Clinical and Administrative data for monthly runs, producing rates for all NCQA HEDIS Measures.
• Primary point of contact for HEDIS Auditor and vendors to ensure all submissions and deliverables are presented within the required timeline during the 18-month audit.
• Responsible for reporting and data submissions to the State of Texas and EQRO for annual HEDIS-related requirements.

Performance Improvement

• Leads and implements quality improvement initiatives and education programs to support improved performance metrics and ratings.
• Works collaboratively with the Quality Director on process improvement projects (PIPS) required by the State and internally created (Providing data reporting to substantiate program impact).
• Partners with operational leaders to identify opportunities for improvement related to performance metrics/ratings and provides recommendations.

Regulatory

• Develop processes to maintain compliance with regulatory agencies and accrediting bodies. Ensures operations are carried out in compliance with these regulations.
• Works collaboratively with others to validate and sustain compliance with regulatory and accreditation standards.
• Conducts routine compliance audits identifying gaps and implementing remediation plans as necessary.
• Works collaboratively with leadership and/or PCHP Compliance to investigate and respond to matters of concern or alleged violations taking corrective action as necessary.
• Provides timely and accurate responses to requests for information from regulatory agencies and accrediting bodies.

Fiscal Management and Operating Budget

• Operationally responsible for the financial performance of assigned area(s).
• Promote activities to achieve operational efficiency.
• Manage the approved budget through frequent and regular monitoring. Implement written action plans to address variances adjusting strategies as necessary to meet budgetary targets.
• Consider operational outcomes and financial implications when making recommendations to implement new programs or modify current programs.
• Manage staffing levels within established targets.

Talent Management

• Recruit and retain diverse talent with a variety of backgrounds, skills, experiences, and viewpoints that reflect the communities we serve.
• Promote and support a culturally welcoming, inclusive, collaborative, and highly engaged work environment where everyone feels empowered to bring their full, authentic selves to work.
• Accountable for orientation, ongoing education and training, and competency verification for all employees.
• Ensure Human Resource metrics (i.e., retention, vacancy, engagement) meet established targets. Utilize workforce metrics to monitor, identify, and respond to workforce trends.
• Timely completion of employee performance appraisals.
• Conduct regular meetings, inform team of changes in policy or procedure, and provide information regarding overall strategy and direction of the health plan.
• Mentor, coach, and support direct reports with building teamwork, professional development, and education to achieve optimal performance and develop talent.
• Ensure employee engagement survey participation rates and results meet established targets.
• Mandatory requirements are completed timely by employees.
• Required licensure, certification, and/or registry are current and in good standing for all employees.
• Employee performance is monitored and managed. Consult with the Office of Talent Management as appropriate regarding employee performance concerns and disciplinary action.

Professional Accountability

• Acts with the highest integrity and ethical standards while adhering to Parkland's Mission, Vision, and Values.
• Adheres to organizational policies, procedures, and guidelines.
• Completes assigned training, self-appraisal, and annual health requirements timely.
• Adheres to hybrid work schedule requirements.
• Attends required meetings and town halls.
• Recognizes and communicate ethical and legal concerns through the established channels of communication.
• Demonstrates accountability and responsibility by independently completing work, including projects and assignments on time, and providing timely responses to requests for information.
• Maintains confidentiality at all times.
• Performs other work as requested that is reasonably related to the employee's position, qualifications, and competencies.

Job Accountabilities

1. Identifies and analyzes the design of jobs, work processes, workflows, etc. for the area and implements appropriate changes to improve effectiveness, productivity, and efficiency that support the overall goals of PCHP.
2. Stays abreast of the latest developments, advancements, and trends in the field by attending seminars/workshops, reading professional journals, actively participating in professional organizations, and/or maintaining certification or licensure. Integrates knowledge gained into current work practices.
3. Maintains knowledge of applicable rules, regulations, policies, laws, and guidelines that impact the area. Develops effective internal controls designed to promote adherence with applicable laws, accreditation agency requirements, and customer requirements. Seeks advice and guidance as needed to ensure proper understanding.
4. Develops and monitors annual budgets that ensure the department has the necessary funds to carry out the goals and objectives that have been established for the department.
5. Develops, implements, monitors, and revises annual goals and objectives for the department that support the missions and objectives of PCHP.
6. Selects, trains, schedules, motivates, supervises, and evaluates employees making recommendations for disciplinary actions up to and including termination, to ensure maximum utilization of individual and group capabilities. Ensures that assigned employees receive opportunities to further their knowledge.

Parkland Health and Hospital System prohibits discrimination based on age (40 or over), race, color, religion, sex (including pregnancy), sexual orientation, gender identity, gender expression, genetic information, disability, national origin, marital status, political belief, or veteran status.As part of our commitment to our patients and employees' wellness, Parkland Health is a tobacco and smoke-free campus.