Quality Assurance Manager

Overview:

Primary Partners Alliance was founded in 2012 by independent physicians seeking to improve the health of patients and their access to affordable care. We are passionate about what constitutes good health and affordable access to care. We believe everyone should have affordable high-quality care.

Today, Primary Partners and its Affiliated entities manages the health of over 600,000 covered lives with 430 specialists and 270 primary care providers. The ACO Quality Assurance Manager oversees Healthcare Effectiveness Data and Information Set (HEDIS) and quality programs for 60,000 covered lives under Value Based Care agreements. Primary Partners is an industry leader recognized for achieving the #1 ACO quality ranking in Florida, #8th nationally and for delivering one of four affordable access to care delivery models in Florida.

Brief summary of purpose:

The Quality Assurance Manager (QAM) is an extremely important and pivotal position in our organization. This individual will be the lead and an integral part on an interdisciplinary leadership team focused on building a network of high quality and affordable care services in our communities. The QAM is responsible for the network’s achievement of top performance in HEDIS and quality metric results. The QAM establishes strong relationships and is a motivating force for internal support and physician practice personnel responsible for improving care delivery and closing quality gaps.

QAM Qualities

• Self-motivated and driven to achieve results
• Passionate about improving health and affordable access to care
• Relationship builder of diverse individuals and teams
• Creative and organized
• Positive, committed and expressing a can-do attitude
• Learner, teacher, and someone who encourages the obtainment of strength and knowledge in others
• Humble consensus builder, aligner, and motivator
• Comfortable and confident engager, designer and implementer of people-oriented-technology and operational solutions
• Multitasker able to prioritize, focus, and delegate
• Not afraid to jump in and get the job done at any level when needed

Responsibilities:

• Is the organizations lead in quality and engages in, identifies opportunities and advises leadership on all quality-related matters
• Is the internal expert and educator for personnel and practices on quality metrics and what is required to achieve high levels of performance
• Builds relationships and engages and motivates practice personnel directly or through other team members to understand the importance of achieving quality metrics and in taking actions to do so with their patients
• Understands and maintains library of quality of care and coding metrics required by payers and Primary Partners staff
• Monitors progression of practice members towards meeting care plan quality goals, provides feedback and works collaboratively with care team members and through a team model approach to coordinate a continuum of support consistent with meeting quality metric goals
• Working with the Data and Analytics team and the Quality Assurance Administrator and Project Manager, oversees the development of data capture and reporting of quality performance metrics in Lightbeam Health, payer and practice systems
• Oversees tracking and reporting to leadership of quality metric achievement progress
• Advises ACO members in conjunction with the Primary Partners Alliance for Community Health, ACO Clinical Partners, Community and Behavioral Health Partners and others on ways of improving efficiency of meeting quality metrics from an operational and systems perspective
• Develops and fosters relationships with ACO practices, members, vendors and providers to ensure good collaboration and coordination and in streamlining the identification of and closure of care gaps, enhancing quality of life, and promoting cost-effectiveness of care
• Demonstrates positive customer service actions and takes responsibility to ensure ACO member and provider needs are met
• Provides culturally appropriate care coordination and patient engagement advice to practices and demonstrates culturally appropriate behavior with internal teams and when working with ACO members and their teams and/or authorized representatives
• Assesses the ACO practice Member’s knowledge about the management of current disease processes and medication regimen, develops quality improvement care protocols and provides teaching to increase Member/caregiver knowledge. Works with the members to leverage Alliance for Community Health team members in support of patients with learning how to self-manage his or her health needs, social needs or behavioral health needs
• Assess and educate ACO members in building preventative screenings and quality metric achievement such as vaccines, screenings according to established protocols and program processes and initiatives involving quality metrics into their normal course of care

Education

Bachelors (or advanced) degree a health care related field preferred.

License/Certifications

Other: Satisfactory Criminal Offender Record Information (CORI) results

Experience

• Advanced knowledge of HEDIS, MIPS, NCQA quality measures
• 1+ years of experience managing chronically ill members or experience in a coordinated care program
• Understanding of Hospitalization experiences, the impacts and needs after discharge
• Experience with telephonic interviewing skills and working with a diverse population, that may also be Non-English speaking, preferred
• Effective case management and care coordination skills and the ability to assess a member’s activities of daily function and independent activities of daily function and the ability to develop and implement a care plan that meets the member’s need working in partnership with a care team, preferred
• Familiarity with NCQA case management requirements, preferred
• 2+ years of experience working with people that may be encountering social, economic, and/or multi complex medical and or behavioral health conditions, preferred
• Ability to communicate and collaborate with PCP, community and ACO partners to manage members care required
• Experience working in an ACO, MSO, CIN, managed care health plan, community social service agency, skilled home health care agency, State Agency such as the Department of Mental Health (DMH), Department of Developmental Services (DDS), Department of Children and Families (DCF), and/or the Department of Youth Services (DYS), or other agency servicing those in need preferred

Job Type: Full-time

Pay: $75,000.00 - $85,000.00 per year

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift
• Monday to Friday

Education:

• Bachelor's (Preferred)

Experience:

• Managing Chronically Ill Members: 1 year (Preferred)
• Healthcare: 1 year (Preferred)
• HEDIS: 1 year (Preferred)
• MIPS: 1 year (Preferred)
• NCQA standards: 1 year (Preferred)

Work Location: Hybrid remote in Clermont, FL 34711