Leader, Performance Management, Regulatory & Health Equity

Status: Full Time, Exempt

The Leader of Quality Performance Management, Regulatory Compliance and Health Equity is responsible for oversight, implementation, performance monitoring and adherence to State and Federal regulations & policies related to Quality Performance, Health Equity and Social Determinants of Health (SDOH) for NYS Government Programs and Medicare.  The Leader will have responsibilities for management, performance, and oversight of all regulatory Quality Programs (QIP, PIP, CCIPs).  The Leader will be the subject matter expert (SME), working with cross functional departments, including Health Management, Provider and Network teams, Data Analytics, Compliance, Operations, and other teams to advance the Quality Health Equity and SDOH strategies.  The Leader is responsible to integrate, imbed, and ensure compliance to State and Federal Health Equity and SDOH requirements in the Quality program designs.  The Incumbent will support the day-to-day function, oversee timeliness reporting, guide, and monitor interventions to improve QPM.

Responsibilities:

• Achieve objectives by supporting planning, applying regulatory requirements to all Quality initiatives and programs.
• Prepare, maintain, and complete workplan activities for regulatory compliance, SDOH and Health Equity standards.
• Identify performance trends, improvement areas, then plan and implement changes to maintain compliance and improve performance.
• Identify cross-project dependencies and opportunities to work with key areas to improve outcomes and the customer experience.
• Represents the Quality team on internal and external Regulatory committees and meetings.
• Apply PDSA (Plan-Do-Study-Act) and CPI (continuous process improvement) principles to all areas of accountabilities.
• Work cross functionally with technical and data teams to communicate business requirements for reporting, oversee and/or perform UAT (user acceptance testing) as needed.
• Be a customer advocate for SDOH and Health Equity needs, related to access to care and achieving optimal outcomes while maintaining fiscal balance.
• Coordinating multiple stakeholders to develop and implement innovations that allow for continuous improvement in quality performance to improve customer outcomes.
• Monitoring, and evaluating the effectiveness of outcomes.
• Monitoring, evaluating, and ensuring compliance with all current regulatory requirements and upcoming regulatory changes.
• Implement continuous process improvement and innovation to identify, promote, and drive activities that support MVP customers. 
• Timely communication on status of projects including gaps, risks and needs using a workplan and/or project tracker, or other standard documentation tool.
• Oversee, manage, guide, and support the day-to-day function of direct reports.
• Other duties as assigned to support the Quality, Health Management and MVP strategic goals.

Position Qualifications

Minimum Education:

Bachelor's degree in health care, public health, business, or related field.

Minimum Experience:

3+ years' experience in a Health Care setting working in Quality programs.

3+ years' experience with Medicaid and Medicare programs, including direct knowledge of CMS, NCQA and state program requirements. QARR experience highly preferred.

3+ years' progressive experience in a leadership role, managing a team of direct and indirect reports.

Required Skills:

• Quality regulatory experience (QPMs, CMS, NCQA, Medicaid state programs).
• Demonstrated use of PDSA/PDCA.
• Application of Quality Improvement and Quality Management tools to manage and monitor regulatory reports and submissions.
• QPM program design, implementation, and monitoring.
• Risk assessment for Quality Regulatory adherence.
• Project Management experience with demonstrated success with prioritizing projects, initiatives, and tasks in a fast-paced environment.
• Business analysis experience preferred.
• Demonstrated experience with program implementation, managing multiple projects or programs while achieving desired results required.
• Demonstrated success working cross-functionally to advance strategic goals.
• Experience with SDOH, Health Equity programs including program implementation, management, and monitoring.

About MVP

MVP Health Care is a nationally recognized, not-for-profit health insurer caring for members in New York and Vermont. Committed to the complete well-being of our members and the communities we serve, MVP makes health insurance more convenient, more supportive, and more personal. We are powered by the ideas and energy of more than 1,700 diverse employees from all backgrounds, committed to having a positive impact on the health and wellness of everyone we serve.

At MVP, we are committed to providing competitive employee compensation and benefits packages. The base pay range provided for this role reflects our good faith compensation estimate at the time of posting. Specific employment offers and associated compensation will be made individually based on several factors, including but not limited to geographic location; relevant experience, education, and training; and the nature of and demand for the role.

In addition, we offer a comprehensive benefits package that includes:

• Considerable paid time away from work including PTO (Paid Time Off), sick time, service time off, paid holidays, and floating holidays, allowing you to take time off when it suits you best.
• Competitive 401(k) employer matching and profit-sharing program to help you save for your retirement.
• Low premium health benefits including medical, dental, and vision coverage to support your well-being and that of your family.
• Life insurance and disability coverage to ensure financial security for you and your dependents.
• An array of optional benefit plans such as accident insurance and specified disease coverage to protect you from the unexpected.
• Full tuition reimbursement (up to the IRS limit) for approved courses and programs that support continuous learning.
• A best-in-class employee Well-Being program to support all dimensions of your health and wellness.

MVP Health Care analyzes the latest market data to determine employee compensation. Compensation figures listed in a job posting are subject to change as new market data becomes available. The salary range, other compensation, and benefits information is accurate as of the date of this posting. MVP Health Care reserves the right to modify this information at any time, subject to applicable law. More detailed information about totalcompensation and benefits will be provided during the hiring process.

MVP Health Care is an Affirmative Action/ Equal Employment Opportunity (PDF). We recruit, employ, train, compensate, and promote without regard to race, religion, creed, color, national origin, age, gender, sexual orientation, marital status, disability, genetic information, veteran status, or any other basis, e.g., Pay Transparency (PDF), and the Know your Rights protected by applicable federal, state or local law. Any person with a disability needing special accommodations to the application process, please contact Human Resources at hr@mvphealthcare.com
 

Please apply and learn more - including how you may become a proud member of our team.