Manager, Quality Data

L.A. Care Health Plan•Los Angeles, CA

About The Position

The Manager of Quality Data is an important role on the quality data team. This position will work closely with technical, clinical, and compliance personnel to ensure accurate and timely delivery of Healthcare Effectiveness Data and Information Set (HEDIS) and Survey data to regulatory entities, partners and other stakeholders. This position plays a key role in optimizing data procurement and streamlining operational processes for Extract, Transform, and Load (ETL). The manager in this role will be responsible for the performance of the HEDIS data analysts which includes Senior Data Analyst, Data Analysts and Survey Analysts. This position is responsible for data process regarding HEDIS and Surveys, including Member and Provider experience, Health Outcomes and others which together are used for National Committee for Quality Assurance (NCQA) accreditation and L.A. Care provider, group and plan partner performance management, which are high profile projects for L.A. Care. This position will create and maintains policies and procedures relevant to HEDIS and Survey data process involving rate calculations, reports and quality assurance checkpoints which may involve other L.A. Care teams. This position will also coordinates with vendors, provider groups and plan partners to maximize data completeness, analyzing quality data results to identify improvement opportunities. In addition to these responsibilities, this position works with product evaluation, reviews and manages the budget, accounts for variations, works with the legal advisor on review and vetting of proposals and contracts, participates in compliance audits such as State Department of Health Care Services (DHCS), HEDIS, NCQA and others as needed and will contribute to executive summary documentation and presentations on outcomes. The Manager participates in Quality Improvement initiatives and committee meetings. The Manager in this role will have a pivotal role in the success of L.A. Care as public reporting and data process efficiency are of utmost importance. The Manager, Quality Data manages all aspects of running an efficient team, including hiring, supervising, coaching, training, disciplining, and motivating direct-reports.

Requirements

Bachelor's Degree in Mathematics or Economics
In lieu of degree, equivalent education and/or experience may be considered.
At least 6 years of clinical outcomes review and quality data experience with strong skills in data validation.
At least 4 years of leading staff or supervisory/management experience.
At least 3 years of experience with HEDIS and Surveys for example, Consumer Assessment of Healthcare Providers and Systems (CAHPS), Consumer Assessment of Healthcare Providers and Systems Clinician & Group Survey (CG-CAHPS), Consumer Assessment of Healthcare Providers and Systems Medicare Advantage and Prescription Drug Plan (CAHPS- MAPD), Qualified Health Plan Enrollee Experience Survey (QHP-EES), Health Outcome Survey (HOS), etc.
Equivalency: Completion of the L.A. Care Management Certificate Training Program may substitute for the supervisory/management experience requirement.
Communication skills with technical staff in a NCQA accredited health plan.
Advanced programming skills working with data types such as membership, provider, claims and encounters.
Working knowledge of MS Access, Excel, and Word software.
Able to manage project timelines, requested deliverables and developing and maintaining prioritization thereof.

Nice To Haves

5 years experience in advanced programming skills working with data types such as membership, provider, claims and encounters
Healthcare Effectiveness Data and Information Set (HEDIS) Compliance Auditor
Registered Nurse (RN) - Active, current and unrestricted California License
Registered Health Information Administrator (RHIA) - active and valid
Registered Health Information Technician (RHIT)

Responsibilities

Manages the HEDIS and Survey Projects: Updates internal policies and procedures that pertain to functions related to data process, data collection, and Health Insurance Portability and Accountability Act (HIPAA) compliance. Present to groups as needed.
Staff support and administration; Works with staff to set up incentive goals, and work metrics; Monitors activity to assure staff are engaged; Works with the technical staff to develop databases for data capture and reporting; Conducts verbal or written counseling, writes performance improvement plans, and resolves issues impacting productivity.
Works with and presents to Plan Partners and provider groups to optimize data quality and completeness.
Works with the technical staff to produce and assure the delivery of reports for submissions required by NCQA, Centers for Medicare and Medicaid Services (CMS), Managed Risk Medical Insurance Board (MRMIB), and other regulatory or accreditation agencies.
Resolves issues impacting delays in timelines, staffing, and/or production.
Initiates and participates in performance/quality improvement initiatives and workgroups.
Sets work standards and monitors production as indicated by the project plan. Supervise staff , including, but not limited to: monitoring of day to day activities of staff, monitoring of staff performance, mentoring, training, and cross-training of staff, handling of questions or issues, etc. raised by staff, encourage staff to provide recommendations for relevant process and systems enhancements, among others.
Oversight of data vendor services.
Perform other duties as assigned.