Quality Analyst

TX-HHSC-DSHS-DFPS • Austin, TX

1d • Hybrid

About The Position

The Texas Health and Human Services Commission (HHSC) Medicaid and CHIP Services (MCS) division seeks a highly qualified candidate to fill the position of Program Specialist VI. The Program Specialist VI reports to the Managed Long-Term Services and Supports (MLTSS) Quality Manager and works as part of the Quality Assurance team within Quality and Program Improvement to improve health outcomes for Texas Medicaid and CHIP members. This position works under minimal supervision with extensive latitude for the use of initiative and independent judgment. The Program Specialist VI performs highly advanced consultative and technical work, including developing and implementing MLTSS quality initiatives and evaluating the performance of contracted managed care organizations (MCOs).
MCS is driven by its mission to deliver quality, cost-effective services to Texans. This position makes a significant contribution to MCS’s mission by using data-driven evidence-based approaches to hold Medicaid and CHIP MCOs accountable, ensure access to high-quality care, and drive quality-based innovation. The ideal candidate thrives in an environment that emphasizes: teamwork to achieve goals, excellence through high professional standards and personal accountability, curiosity to continuously grow and learn, critical thinking for effective execution, and integrity to do things right even when what is right is not easy.

Requirements

• Knowledge of State and federal laws, regulations, and processes regarding Medicaid managed care, including managed long-term services and supports.
• Managed long-term services and supports quality measures, quality assurance practices, and performance improvement monitoring.
• Skill in Interpreting state and federal laws, regulations, and processes regarding Medicaid managed care.
• Leading workgroups, working with multiple stakeholders, and providing oversight to contracted vendors.
• Written and oral communication, including the ability to make public presentations, write technical information in an understandable format, and produce sophisticated research reports.
• Planning and organization.
• Ability to Work collaboratively across MCS to accomplish objectives.
• Work cooperatively as a team member in a fast-paced, deadline-orientated environment.
• Balance team and individual responsibilities.
• Work independently and operate effectively within established guidelines and timeframes.
• Perform work with a high degree of attention to detail.
• Analyze data to identify trends, problems, and issues.
• Analyze reports to verify data integrity.
• Develop and interpret statistical data charts, maps and tables.
• Develop and evaluate policies and procedures.
• Solve complex problems.
• Implement creative solutions to problems.

Nice To Haves

• Graduation from an accredited four-year college or university. Master's degree is preferred.
• Experience with MLTSS quality and managed care.
• Experience leading projects or initiatives and addressing complicated issues or problems including analyzing policies, data and other complex information.
• Experience in communicating, including making presentations and preparing technical information in an understandable format for internal management and external publication.

Responsibilities

• Develops and manages highly complex initiatives that evaluate and directly impact the performance of managed care organizations within the Medicaid and CHIP managed care programs.
• Plans, develops, coordinates, and implements quality related program and operational policy changes and initiatives.
• Develops recommendations for changes in programs and operational policies related to managed care and provides input on MLTSS and health quality initiatives.
• Reviews and analyzes quality performance information including technical reports, datasets, and analyses completed by Texas’s external quality review organization.
• Provides consultative services and technical recommendations to MCOs on applicable topics and works with MCO staff to resolve technical and operational issues.
• Works closely with other program areas within HHSC, and associated vendors, to ensure operational processes and systems are coordinated.
• Works with staff and external stakeholders to identify risks/issues and develop mitigation strategies and solutions.
• Identifies quality gaps, improves reporting processes, tracks quality improvements and enhances current systems.
• Facilitates and participates in workgroups, setting goals and objectives and providing work products related to quality in managed care programs and policy.
• Works collaboratively across MCS to identify innovative and effective solutions for clients and staff.
• Works with other areas of MCS to review and improve understanding of quality metrics and reports and develops strategies to improve health plan performance.
• Prepares high-quality research, analyses, summaries, and other documents as assigned.
• Develops materials for preparation or follow up to workgroups and meetings conducted for internal and external stakeholders.
• Interprets agency rules and federal and state laws.
• Oversees compliance with program policies, procedures, statutes, and rules and takes corrective action if needed.
• Develops reports, policies and procedures, and analysis tools.
• Analyzes legislation related to quality initiatives delivered through managed care and suggests changes to legislative language.
• Implements quality-related legislative initiatives.

Benefits

• comprehensive benefits package includes 100% paid employee health insurance for full-time eligible employees
• defined benefit pension plan
• generous time off benefits
• numerous opportunities for career advancement

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 1-10 employees