Quality Programs Manager

Univera Healthcare•Rochester, NY

About The Position

Under the guidance of assigned management, the Quality Programs Manager manages complex programs and projects and provides higher-level operational and technical solutions using a holistic, end-to-end approach to quality performance, including accreditation, regulatory compliance, member experience, and health plan performance. The role is an integral part of the team and serves as the primary contact for internal and external stakeholders on program matters. The manager provides leadership and direction to ensure program submissions meet specifications and deadlines and monitors results on an ongoing basis. The position oversees day-to-day program operations, assesses compliance with program standards, manages multiple projects and changing priorities, and maintains an enterprise-wide perspective. It develops program plans, schedules, work plans, metrics, dashboards, and reports; monitors outcomes and progress; addresses issues and risks; and communicates program status to executive management and other stakeholders. The manager leads matrixed teams and cross-functional work, coordinates program reviews, manages scope and change, and oversees program economics, budgets, staffing, resources, and contingency planning. The role manages internal and external stakeholder, vendor, auditor, and regulator relationships; coordinates evidence collection and submissions; and oversees related vendor agreements and compliance. It represents the program in committees and work groups, provides education and coaching on quality improvement and accreditation activities, and promotes continuous improvement, operational efficiency, and a culture of excellence. The position also maintains current knowledge of relevant technologies, project management practices, and regulatory and accreditation requirements, and must protect confidential information and member privacy.

Requirements

Bachelor’s degree in Nursing, Business or Healthcare Administration, Analytics, Project Management, or a related field, and at least 5 years of related work experience; in lieu of a degree, at least 11 years of related work experience.
At least 3 years of project management experience.
Applied knowledge of quality improvement, accreditation, and regulatory compliance.
Demonstrated leadership skills and knowledge of quality principles, problem solving, and quality tools and techniques.
Demonstrated ability to form and foster high-performance cross-functional teams.
Strong verbal and written communication skills, including the ability to communicate internally and externally across disciplines and management levels.
Strong coaching and facilitation skills to drive improvement, matrix ownership, and change.
Strong understanding and application of vendor management skills.
Very strong analytical and business process development skills.
Demonstrated success working in a fast-paced environment and competence in staff leadership and project leadership.
In-depth knowledge of application delivery, management structures, and reporting procedures.
Demonstrated experience integrating enterprise applications.
Demonstrated experience managing teams working under multi-phased and multi-deployment project schedules.
Demonstrated experience communicating with senior management through discussions, written reports, scheduled meetings, and executive-level presentations.
Knowledge and experience in healthcare, health insurance, or a similar industry.
Knowledge of federal, state, and accreditation standards, including NCQA, CMS, IHI, AHRQ, NQF, and NYSDOH reporting requirements.
Ability to work at a workstation while sitting and/or standing, viewing a computer and using a keyboard, mouse, and/or phone for three or more hours at a time.
Ability to work in a home office for continuous periods for business continuity and to travel across health plan service regions as needed.
Ability to lift, carry, push, or pull 15 pounds or less; manual dexterity including fine finger motion; and ability to hear, understand, and speak clearly while using a phone, with or without a headset.

Nice To Haves

Master’s degree.
PMI/PMP certification.
Knowledge of basic statistical concepts and survey design skills.
Current and thorough understanding of federal and state regulations for all lines of business as they relate to the job.

Responsibilities

Manage complex programs and multiple related projects, including scope, priorities, change management, schedules, deliverables, and outcomes.
Oversee day-to-day operations and assess organizational compliance with program standards and requirements.
Develop program plans, work plans, schedules, and appropriate metrics; monitor progress and timeliness to ensure deadlines are met.
Prepare and present trending reports, dashboards, and program status updates to executive management, committees, and other stakeholders.
Identify and troubleshoot issues and barriers, develop and implement solutions, evaluate outcomes, and escalate issues when appropriate.
Coordinate with Quality Measurement to develop and maintain progress reports that measure intervention impact, document compliance, and report program status.
Represent the program in committees and work groups, prepare materials and reports, and make advanced presentations.
Serve as a subject matter expert and ambassador for the program and quality, communicating its relationship to quality rating programs and corporate goals.
Build collaborative relationships across divisions and functions and serve as the primary contact for internal and external program inquiries.
Manage vendor, auditor, and regulator relationships, including calls, site visits, audits, consultants, and staff preparation.
Coordinate collection and submission of evidence required for program requirements and assess compliance.
Oversee development, contracting, implementation, governance, and compliance monitoring of delegation and vendor agreements.
Coordinate program content, oversight activities, and reporting with business areas and monitor agreements for continued compliance.
Maintain program team rooms, artifacts, schedules, and consistent approaches; organize and facilitate regular program reviews and meetings.
Direct and coordinate matrixed team activities across interrelated projects from contract or proposal initiation through operational implementation.
Determine and monitor program costs, budgets, staffing requirements, resources, and risks; develop contingency plans for schedule, staffing, funding, or work changes.
Facilitate management communication about critical path issues, risks, and mitigation approaches.
Select appropriate tools to estimate and plan team work, produce work plans to required standards, and contribute to short- and long-term plans.
Conduct competitive intelligence and research best practices with internal departments and evaluate potential implementation.
Maintain current knowledge of emerging technologies, project management techniques, and applicable regulatory and accreditation requirements; attend relevant training and conferences.
Provide training, guidance, education, assistance, and coaching to staff and stakeholders involved in quality improvement and accreditation activities.
Coach and counsel cross-functional team members to complete activities, meet schedules, and resolve technical or operational issues.
Monitor and evaluate the quality of performance and work products within the role's scope, and foster continuous improvement, efficiency, productivity, and cost reduction.
Maintain confidentiality and member privacy, demonstrate integrity and support organizational mission and values, maintain regular and reliable attendance, and perform other assigned functions.