Kaiser Permanente Atlanta , GA 30301
The Quality Performance Lead (QPL), with minimal supervision, is responsible for the efficient management of all processes designed to improve HEDIS scores to the 90th percentile and obtain and overall 5 Star CMS ratings. The QPL is responsible for performance metric tracking, monitoring and management related to enterprise and local clinical performance metrics, state and local government program (CMS/Stars) ratings, accreditation (NCQA) performance metrics, and payer performance metrics/performance guarantees.
The QPL will develop or assist in the development of internal programs and member facing initiatives to improve HEDIS scores and Star ratings and NCQA ratings. The QPL will provide leadership to cross-functional work teams and programs and provide core subject matter expertise in the critical areas of development, implementation, maintenance, measurement, evaluation, and continued monitoring. This role requires the ability to work closely with and effectively collaborate with physician leadership, analytics, directors, managers, market-based teams, compliance and oversight committees.
Tracks, monitors and evaluates dashboards and other metric sources. Escalates declining metric measures and flat metric measures appropriately.
Communicates changes in scores and cut points to leadership and key stakeholders. Collaborates with team members to develop strategies to manage metrics, monitor changes and communicate meanings to key stakeholders. Works collaboratively with project managers, operations and front line staff and quality team to develop internal processes and programs and member facing initiatives to improve scores and ratings.
Partner and develop strong collaborative relationships with TSPMG, operations, and other members of the quality team to develop strategies and initiatives that ensure improvements in HEDIS, Star, NCQA and other metrics ratings and scores.
Exhibits strong analytic skills, understands and uses data to facilitate decision making. Communicates complex data and changes in scores and cut points in a simple easy to understand and compelling way.
Establish strategies that are consistent with empirically proven programs/evidence, and has a thorough understanding of the drivers and the success factors of leading health care organizations.
Partners across national and regional leaders to ensure all metric initiatives are aligned with other key regional and national initiatives and strategies.
Develops strategic and uniform processes to communicate care gap information to key stakeholders, operations, and providers of care and shares change actions.
Develops or assists in the development of documentation and or workflows related to the design and implementation of improvement interventions including but not limited to telephone scripts, letters, mailers, outreach etc.
Maintains active involvement in public comment periods and strategic planning for all metric related activities and communicates information to key stakeholders.
Minimum three (3) years overall experience in the workforce and health care system and a multi provider setting.
Bachelor's degree OR four (4) years of experience in a directly related field.
High School Diploma or General Education Development (GED) required.
License, Certification, Registration
Demonstrated strong interpersonal/communication skills.
Strong presentation, project management and problem-solving skills required.
Ability to lead through influence.
Strong verbal and written communication skills and presentation skills required.
Decisiveness, action-orientation, personal integrity, capability to preserve in difficult situations and a focus on outcomes.
Demonstrated understanding of HEDIS, CMS stars, NCQA or if no exposure beforehand, demonstrated ability to understand and apply detailed industry specification to the business function.
Self-starter, organized, able to work with minimal supervision, results oriented team oriented approach to problem solving
Good at creative problem solving and decision making, has an eye for detail.
Ability to manage moderately complex situations and programs.
Review reports and records of activities to ensure progress is being accomplished toward specified goals and targets. Leads changes to modify or change methodology as required to redirect activities to attain objectives.
Own and make needed decisions to ensure the successful resolution of all issues, problems and changes necessary to manage the assigned metrics.
Monitor performance metrics against goals and targets for assigned areas, including process measures, outcomes measures and methodologies for implementing programs. Document and present outcome results through operational reports, outcomes studies, presentations and publications.
Analyze policies and procedures to improve processes, programs efficiencies and effectiveness.
Manage programs/metrics and work with project team members to ensure deadlines are met.
Project management, performance improvement, administration or operations experience desired.
Clinical health care operations background is a plus. Understanding of medical economics a plus.
Minimum ten (10) years successful experience in program or project management in a healthcare setting may be considered.
Minimum five (5) years overall experience in the health care industry, preferably in a multi-faceted health care system and a multi provider setting.
Experience in a customer-facing industry may be considered in lieu of healthcare experience.
Master's degree OR six (6) years of experience in a directly related field.
Primary Location: Georgia,Atlanta,Regional Office - 9 Piedmont 9 Piedmont Center 34 Scheduled Weekly Hours: 40 Shift:
Day Workdays: Mon, Tue, Wed, Thu, Fri Working Hours Start: 8::00 AM Working Hours End: 5:00 PM Job Schedule: Full-time Job Type:
Standard Employee Status: Regular Employee Group/Union Affiliation: Salaried, Non-Union, Exempt Job Level:
Individual Contributor Job Category: QA / UR / Case Management Department: Metrics Management Travel: Yes, 15 % of the Time
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