Develop, implement and monitor Medicaid quality improvement programs, systems and initiatives impacting EmblemHealth. Facilitate performance and process improvements related to increasing Quality Incentive Awards and Quality Plan Rankings. Provide Leadership and Oversight for Medicaid Quality initiatives.Responsibilities:
- Upgrade the member onboarding process in concert with Customer Service and implement best practices for Medicaid member onboarding.
- Enhance the Medicaid member call center experience, including ensuring cultural competency, accommodations for individuals w/disabilities in collaboration with Customer Service; evaluate member satisfaction on an ongoing basis.
- Remove barriers and access to care with the Network Team.
- Improve and streamline work/processes, including the referral and authorization process, in collaboration with key stakeholders; with the ultimate goal of enhancing Medicaid member experience.
- Develop & implement product-based action plans; oversee project implementation to meet corporate business goals.
- Work across departments and in collaboration with the Quality Department to vet and ensure that measure strategies and action plans, reflect strategies and actions that will deliver enhanced performance on quality measures.
- Develop strategies and protocols in collaboration with Medical Management to improve PDPQI performance.
- Create scorecards and reporting to track and monitor improvements in PDPQI measures.
- Initiate and implement Medicaid rewards program to close gaps in care.
- Improve member engagement in health and wellness activities as allowed under the VBP Roadmap by implementing a Medicaid rewards program.
- Design and execute Medicaid member outreach campaigns designed to improve CAHPS performance and to enhance member experience and satisfaction.
- Report regularly on member outreach campaigns with respect to productivity and outcomes.
- Create events that promote Medicaid member engagement and improved health outcomes.
- Review all performance of campaigns and redesign onboarding when required.
- Bachelor’s Degree in healthcare, business, finance, mathematics, engineering, applied stats/economic or any other related analytical field; Master’s preferred
- Minimum 5-8 years’ experience in the healthcare or managed care industry, or related field required
- Experience and knowledge with HEDIS/QARR/CAHPS, CMS Star Ratings, and Accreditation process required
- Proven track record of developing/implementing process improvements required
- Ability to utilize appropriate metrics and analytics in order to validate improvements in efficiency/effectiveness required
- Ability to effectively communicate (verbal, written, presentation) to all types and levels of audiences required
- Proficient in Microsoft Office (Word, PowerPoint, Excel, Access) required
We are committed to leveraging the diverse backgrounds, perspectives and experiences of our workforce to create opportunities for our people and our business. We are an equal opportunity/affirmative action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or any other characteristic protected by law.
Depending on factors such as business unit requirements, the nature of the position, cost and applicable laws and regulations, EmblemHealth may provide work visa sponsorship for certain positions.
Process Improvements (Business)
Healthcare Effectiveness Data And Information Set