Manager, Quality Data Reporting and Analytics

Overview

Leads and manages all aspects of data for the HEDIS/STARS/QARR/QIP functions, which includes but are not limited to, data collection and submission, quality control, and reporting and analysis to meet National Committee for Quality Assurance (NCQA), Centers for Medicare and Medicaid Services (CMS) and New York State Department of Health (NYSDOH) requirements. Oversees analytical projects related to operational, clinical, and quality analyses and ad-hoc requests. Acts as the primary technical contact between VNS Health Plans and HEDIS vendor. Works with Quality Management leadership and staff to assess and support data/reporting needs. Works under general direction.

For Care Management Organization (CMO) Only: The functional domain is Care Management Reporting for internal operations and contracted payors.

Compensation Range:$93,400.00 - $116,800.00 Annual

What We Provide

• Generous paid time off (PTO), starting at 30 days of paid time off and 9 company holidays  
• Health insurance plan for you and your loved ones, Medical, Dental, Vision, Life Disability   
• Employer-matched retirement saving funds  
• Personal and financial wellness programs   
• Pre-tax flexible spending accounts (FSAs) for healthcare and dependent care    
• Generous tuition reimbursement for qualifying degrees  
• Opportunities for professional growth and career advancement   
• Internal mobility, generous tuition reimbursement, CEU credits, and advancement opportunities    
• Referral bonus opportunities   

What You Will Do 

• Manages the day to day operations of a team responsible for data collection, analysis, quality control and regulatory reporting. Troubleshoots issues, ensures deadlines are met, adheres to agency policies/standards and oversees staff.
• Coordinates, prepares and ensures the HEDIS/STARS/QARR/QIP annual/quarterly submission process is complete and accurate to ensure successful submissions for Medicare Advantage, FIDA, HIVSNP and MLTC. Ensures data exchanges with vendor are valid, reliable, and meet all required timelines. Addresses and closes all outstanding issues in a timely manner. Supports Quality Management leadership as necessary with defining operational improvements within the health plan following the annual HEDIS/STARS/QARR/QIP audit. Evaluates changes in requirements and modifies reporting processes as necessary.
• Serves as a subject matter expert regarding the data utilized for measurement, quality improvement opportunities and approaches, analytics, and interventions and initiatives. Maintains strong knowledge of regulatory requirements, quality rating systems, and technical specifications.
• Creates summary reports documenting trends and identifying statistically significant findings. Constructs reports, tables, graphs, and statistical analysis; provides explanatory documentation as appropriate. Summarizes large volumes of data in user-friendly reports that include statistical summaries, qualitative and quantitative analyses.
• Develops, codes, runs, and/or prepares formatted reports to support critical Quality Improvement functions (e.g., Performance Improvement Projects, including HEDIS, state-based measure reporting and medical record review). Notes statistically significant finding with senior management and makes recommendations to business customers based on empirical findings.
• Develops methods for consistency and data validation to ensure accurate data selection and appropriate application development.
• Builds and maintains working relationships with internal and external customers.
• Performs peer data quality reviews, validating data and processes to ensure accuracy, completeness, and consistency of department output; recommends process improvements as necessary.
• Performs all duties inherent in a managerial role. Ensures effective staff training, evaluates staff performance, provides input for the development of the department budget, and hires, promotes, and terminates staff and recommends salary actions as appropriate.
• For Care Management Organization (CMO) Only:
• Manages the day to day operations of a team responsible for contractual and regulatory reporting.
• Coordinates, prepares and ensures the Care Management Organization annual/quarterly submission process is complete and accurate Ensures data exchanges with vendor are valid, reliable, and meet all required timelines. Addresses and closes all outstanding issues in a timely manner. Supports Care Management Organization leadership as necessary with defining operational improvements. Evaluates changes in reporting requirements and modifies reporting processes as necessary.
• Lead and manages all aspects of data for the Care Management Organization functions which includes but are not limited to, data collection and submission, quality control, and reporting and analysis to meet Client Contracts, National Committee for Quality Assurance (NCQA), Centers for Medicare and Medicaid Services (CMS) and New York State Department of Health (NYSDOH) Care Management Standards
• Oversees analytical projects related to operational, financial, clinical, and quality analyses and ad-hoc requests. Works with Care Management Organization leadership and staff to assess and support data/reporting needs. Works under general direction of the Vice President for Care Management Solutions
• Participates in special projects and performs other duties as assigned.

Qualifications

Education:

• Bachelor's Degree in Computer Science, Information Systems, Public Health, Healthcare Informatics, Health/Public Administration or the equivalent work experience required
• Master's Degree preferred

Work Experience:

• Minimum of five years of experience managing complex data analysis and interpretation and HEDIS/QARR/STARS/QIP, preferably in a Managed Care organization required
• Prior supervisory/managerial experience preferred
• Extensive knowledge and experience with NCQA, NYSDOH and CMS measurement, reporting and regulatory requirements required
• Solid understanding of the end-to-end HEDIS cycle (e.g. abstraction, data submission, audit, etc.) required
• Advanced proficiency with SAS, SQL and Excel required. Strong analytical and statistical skills (both qualitative and quantitative) required
• Strong planning, organizational, and problem solving skills, including the ability to prioritize and organize a variety of tasks across cross-functional teams and external entities required
• Effective oral, written and interpersonal communication skills required
• Exceptional critical thinking, problem solving, communication and client service skills required
• For CMO Only:
• Solid understanding of the end-to-end CMS STARS related cycle (e.g. abstraction, data submission, audit, etc.) required
• Extensive knowledge and experience with Care management standards related to NCQA, NYSDOH and CMS measurement, reporting and regulatory requirements required