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SalaryOver 35 years strong and fueled by 1,700 smart, passionate employees across New York state and Vermont, MVP is full of opportunities to grow. We are a nationally recognized, award-winning leader for a reason. The beating heart of our company is a wide range of employees from a diverse set of backgrounds—tech people, numbers people, even people people—working together to make health insurance better. If you are ready to join a thriving, mission-driven company where you can create your own opportunities and make a positive difference—it’s time to make a healthy career move to MVP!
Status: Full Time, Exempt
The Quality Program Manager of Regulatory and Compliance facilitates and participates in the implementation of the Quality Improvement Program organization wide. This healthcare professional coordinates the planning, monitoring, and evaluation of the Quality and Regulatory Readiness program. They participate in planned and unplanned regulatory visit activity and promote collaborative practice among departments/services for improved quality outcomes, processes of care and Regulatory Compliance.
Roles & Responsibilities
- Support all aspects of quality programs and projects to measure, monitor and improve the quality of the care and service provided to members for Medicare, and NY State Government programs.
- Track, monitor and implement programs to assure compliance with all NY and VT State and Federal quality regulations, quality standards.
- Lead on development, maintenance, socialization, and submission of (where applicable) quality improvement department policies and procedures, quality of care complaints, Quality Improvement Program Description and Annual Reports, Quality Work Plan, Quality Improvement Committee, State and Federal quality performance improvement projects (Performance Improvement Projects (PIP) Quality Performance Matrixes (QPMs), Chronic Condition Improvement Project (CCIP), etc), Quality Improvement Strategy (QIS), and the quality components of HARP and Essential Plan.
- Cross functionally manages quality projects business priorities to achieve quality goals and meet state and federal regulatory requirements.
- Lead the coordination, development, tracking, and analysis of actions and outcomes against the goals for assigned regulatory and mandated quality performance improvement project(s) across all lines of business, reporting requirements, and corrective action plans required by CMS, NYSDOH, NCQA, and other regulatory agencies with the goal to achieve and maintain compliance.
- Develop and maintain positive business relationships with external organizations, vendors, regulatory agencies.
- Develop and maintain applicable data collection and reporting including submitting reports timely to appropriate parties for review and final submission.
- Establish cross-department workgroups to address progress towards established goals.
- Initiate, monitor and track projects ensuring that project timelines are adhered to and all projects are reviewed and approved by necessary and appropriate individuals.
- Collaborates with key stakeholders, peers, and other departments to facilitate and monitor the timely completion of agreed upon corrective action plans from internal or external findings.
- Regularly monitor regulatory or government policy/methodology updates, changes, and industry news, and assess and address potential impact from changes related to the product line. Incorporate updates as needed to Quality Improvement Program Description.
- Prepare reports and present the activities and analysis to the to the appropriate agencies such as DOH, DFS, IPRO, or internally to the Quality Committees.
- Create and update Quality Improvement regulatory reports to maintain compliance with relevant federal, state and accreditation regulations and standards.
- Support quality leadership reporting and information needs during plan and public meetings with the regulators (CMS, DOH, DFS, IPRO) when addressing performance and quality improvement projects.
- Maintains effective communication and working relationships with a wide variety of staff (internal stakeholders) to support and facilitate quality-related initiatives.
- Other related tasks/projects as directed or required.
Bachelor’s Degree in Nursing, Social Work, Business Administration, Public Health or Health Sciences or related degree strongly preferred. Candidates who possess an associate degree with the related experience may also be considered.
Minimum Experience:
- 3 – 5 years’ experience in healthcare or managed care industry preferred.
- Medicaid, Medicare and/or Quality Regulatory experience.
- Experience with PIP, CCIPs and Quality Improvement Projects required.
- Experience with Quality Improvement and/or with HEDIS strongly preferred.
- Experience working with State and Federal Quality regulatory agencies and knowledge of Quality Improvement regulations strongly preferred.
- Possess strong planning skills with the ability to effectively prioritize of tasks, projects, etc. in a dynamic environment.
- Proficient with MS Office Suite (Word, Excel, etc.) and experience with databases and information tracking programs preferred.
- 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.
- Demonstrated success working cross-functionally to advance projects and initiatives.
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 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.
