Provider Program Quality & Integration Consultant I/II

Univera Healthcare•Buffalo, NY

1d•$60,410 - $129,384

About The Position

Summary: The Provider Program Quality & Integration Consultant facilitates the development and effective implementation of quality and incentive programs and contracts. This work directly impacts the Excellus clinical provider network and member populations. As an individual contributor, this role is a combination of researcher, consultant, strategist, and analyst that facilitates the successful execution of business strategy. The incumbent builds vision, consensus, and commitment among stakeholders such as physicians, nurses, health system executives, quality leadership, vendor partner leadership, and community leaders using industry measurement methodologies, clinical best practice, and empirically sourced change management practices. This position serves as the subject matter expert in all aspects of quality improvement, measurement, and network implementation to increase efficiency and productivity while reducing waste and costs. Essential Accountabilities: Level I Develops, negotiates, administers, and maintains contracted quality improvement programs: Health plan quality goal and national measurement SME, including CMS, HEDIS, QARR, STAR, CAHPS measures. Data mining and analysis ability to formulate solutions and narrate program value stories. Process improvement, healthcare quality trend and project leadership SME. Locates and submits clinical evidence/best practice associated with program development and implementation to inform network and vendor proposals. Evaluates and reports quality program statuses and outcomes to determine impact of interventions using direct and proxy measurement and validation. Develops process standardization and workflow recommendations for quality programs and contracts in development. Supports and executes network and vendor programs which improve the quality, safety, and accessibility of care while lowering costs through implementation of strategic initiatives. Ensures program alignment with organizational goals and existing provider network relationships. Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies’ mission and values, adhering to the Corporate Code of Conduct, and leading to the Lifetime Way values and beliefs. Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures. Regular and reliable attendance is expected and required. Performs other functions as assigned by management. Level II (in addition to Level I Accountabilities) Manages network and vendor engagements including, vendor selection, contract negotiation, contract process oversight, and vendor implementation with other key business areas as appropriate. Provides oversight and direction in managing day to day operations of complex projects and programs, including associated reporting while remaining compliant with mandates. Independently develops novel program proposals focused on quality improvement and cost savings utilizing network relationships and competitive market analysis. Provides recommendations, builds collaboration, and focuses team efforts through regular presentation. Takes the initiative to interface with matrixed groups related to program development and implementation. Takes a systematic delivery view of the portfolio: identifying, developing, and managing cross-dependent projects, to increase efficiency and effectiveness while addressing barriers and risks. Is a primary contact for matrixed implementation of initiatives, including oversight of strategic programs that involve external organizations. Educates, mentors, and coaches members of the program team throughout the course of development and implementation to ensure the goals of the program are realized in alignment with its strategic mission and vision. Works closely with those accountable for driving clinical changes from both the delivery system and the Health plan to obtain feedback regarding the viability of programs and provider needs. Participates in critical activities such as strategic planning and thought leadership at a departmental, cross functional and organization level.

Requirements

Minimum of 5 years of related work experience.
Bachelor’s degree in Nursing, Business or Healthcare Administration, Analytics, Project Management, or related fields preferred.
Applied knowledge of quality improvement, accreditation, or regulatory compliance.
Demonstrated quality principles, proficiency in problem solving and quality tools/techniques.
Strong communication skills required, including ability to effectively communicate verbally and in writing, internally and externally, and across the organization and all levels of management.
Strong facilitation skills.
Strong understanding and application of vendor management skills.
Skilled speaker and presenter experienced in defining, socializing, and sustaining change across diverse groups.
Very strong analytical and business process development skills.
Demonstrated experience in project leadership or principles such as Lean Six Sigma, CPC, process mapping, tests of change, or PDSA cycles.
Demonstrated experience communicating with senior management in various formats, informal discussions, written reports, scheduled meetings, and executive level presentations.
Knowledge and experience working in the healthcare, health insurance or similar industry.
Three years of additional related experience.

Nice To Haves

PMI Certification/ PMP Certification or other project management certification preferred.
Demonstrated knowledge of network and vendor experience in relation to quality.
Prior program implementation experience preferred.
Prior network and product experience.

Responsibilities

Develops, negotiates, administers, and maintains contracted quality improvement programs
Health plan quality goal and national measurement SME, including CMS, HEDIS, QARR, STAR, CAHPS measures.
Data mining and analysis ability to formulate solutions and narrate program value stories.
Process improvement, healthcare quality trend and project leadership SME.
Locates and submits clinical evidence/best practice associated with program development and implementation to inform network and vendor proposals.
Evaluates and reports quality program statuses and outcomes to determine impact of interventions using direct and proxy measurement and validation.
Develops process standardization and workflow recommendations for quality programs and contracts in development.
Supports and executes network and vendor programs which improve the quality, safety, and accessibility of care while lowering costs through implementation of strategic initiatives.
Ensures program alignment with organizational goals and existing provider network relationships.
Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies’ mission and values, adhering to the Corporate Code of Conduct, and leading to the Lifetime Way values and beliefs.
Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures.
Regular and reliable attendance is expected and required.
Performs other functions as assigned by management.
Manages network and vendor engagements including, vendor selection, contract negotiation, contract process oversight, and vendor implementation with other key business areas as appropriate.
Provides oversight and direction in managing day to day operations of complex projects and programs, including associated reporting while remaining compliant with mandates.
Independently develops novel program proposals focused on quality improvement and cost savings utilizing network relationships and competitive market analysis.
Provides recommendations, builds collaboration, and focuses team efforts through regular presentation. Takes the initiative to interface with matrixed groups related to program development and implementation.
Takes a systematic delivery view of the portfolio: identifying, developing, and managing cross-dependent projects, to increase efficiency and effectiveness while addressing barriers and risks.
Is a primary contact for matrixed implementation of initiatives, including oversight of strategic programs that involve external organizations.
Educates, mentors, and coaches members of the program team throughout the course of development and implementation to ensure the goals of the program are realized in alignment with its strategic mission and vision.
Works closely with those accountable for driving clinical changes from both the delivery system and the Health plan to obtain feedback regarding the viability of programs and provider needs.
Participates in critical activities such as strategic planning and thought leadership at a departmental, cross functional and organization level.