CCO Quality Metrics Program Manager

PacificSource Health Plans•Bend, OR

1d•$72,444 - $126,777•Hybrid

About The Position

PacificSource is seeking a CCO Quality Metrics Program Manager to lead the development, implementation, and management oversight of the company’s Coordinated Care Organization (CCO) Quality Incentive Measures (QIM) program. This role involves facilitating multi-disciplinary teams, staying updated on Oregon Health Authority (OHA) policies, and collaborating with internal and external stakeholders to improve QIM performance. The position requires fluency with CCO QIMs, including metric specifications, calculations, and data sources, as well as the ability to interpret complex data to inform quality improvement strategies. PacificSource is an equal opportunity employer committed to diversity and fostering an inclusive work environment.

Requirements

Minimum of 5 years of experience in managed care with emphasis on quality improvement programs.
Experience with Oregon Medicaid, program development, project management, and quality improvement strongly preferred.
Proven track record of managing multiple high-risk, high-visibility, initiatives from definition through implementation.
Bachelor’s Degree required in a related field.
Candidates with an associate’s degree and 2 years of relevant experience, or a high school diploma and 4 years of relevant experience, in addition to the required minimum years of work experience will also be considered.
Knowledge of Medicaid programs, CCO structure, incentive metrics programs, national measure specifications and quality improvement strategies strongly preferred.
Solid experience in using computers and various software applications including Word, Excel, PowerPoint, Outlook, SharePoint and Tableau.
Strong organizational skills and attention to detail.
Expertise in project management, thorough understanding of health care operations, process improvement, business analysis and program planning and evaluation.
Ability to motivate others, strong interpersonal and communication skills (oral and written).
Stoop and bend.
Sit and/or stand for extended periods of time while performing core job functions.
Repetitive motions to include typing, sorting and filing.
Light lifting and carrying of files and business materials.
Ability to read and comprehend both written and spoken English.
Communicate clearly and effectively.

Nice To Haves

Graduate degree preferred.

Responsibilities

Lead, develop, and implement CCO QIM multi-year work plans to support continuous quality improvement and achieve strategic goals.
Collaborate with and work cross functionally to influence, lead, and promote change that drive continuous quality performance improvement.
Accountable for ensuring responsible parties are improving QIM performance both internally and externally.
Oversee metric data flow and ongoing monitoring of performance across quality measures.
Analyze data to understand patterns in performance and variations across populations that can support quality improvement efforts and equity-focused strategies.
Identify and implement strategic and tactical internal and community initiatives aimed at maximizing member outcomes and QIM results across all PacificSource CCO regions.
Serve as a core resource and point of contact for internal and external partners, including the OHA, applying in depth understanding of specifications, data sources and other key aspects of the CCO QIM program across all regions.
Report out on current metric performance, strategy, potential risks and program developments to internal leadership and governing bodies.
Participate in statewide and regional workgroups, learning collaboratives, and advisory committee meetings to stay informed on metric program development and best practices.
Conduct annual program evaluation, identify areas of opportunities, present findings, and recommendations to key stakeholders and leadership.
Serve as Health Plan subject matter expert on the OHA QIM program and Technical Specifications.
Meet department and company performance and attendance expectations.
Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
Perform other duties as assigned.