Full Job Description
MetroPlus Health Plan provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlus’ network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlus has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.
The primary function of the Member Experience & Loyalty Manager is to provide leadership in developing, implementing, monitoring and coordinating quality improvement initiatives that support the goal of improving CAHPS measures across all lines of business. This position will work directly and collaboratively across all MetroPlus departments and with Provider Groups/Facilities to achieve Plan goals for improving CAHPS measures. This position will serve as the subject matter expert for CAHPS.
Lead the development of root cause analysis, interventions and action plans, project planning, tracking and outcome summary reports.
Monitor and analyze CAHPS outcomes to ensure goals, objectives, outcomes are met.
Monitor for adverse trends, recommend modifications and corrective actions. Develops interim data collection mechanisms to track performance.
Ensure focus on measures that are important for achieving/maximizing quality incentive programs established by regulatory bodies including but not limited to CMS, NYS DOH, etc.
Communicate CAHPS interventions and results to external entities in accordance with applicable program objectives, policies and procedures.
Lead and coordinate CAHPS specific meetings with key stakeholders (internal and external business partners) with regular frequency to achieve CAHPS goals.
Provide reporting to Medicare Stars Director and/or health plan leadership on progress of overall CAHPS performance.
Lead and/or participate in external activities, work group or committees promoting CAHPS goals.
Participate in relevant committees and work groups; make presentations, prepare reports, data or other materials for committee presentation.
Assist in the maintenance of contract to administer the CAHPS project.
Particpate in special projects as needed
Master’s Degree in Healthcare Administration, Public Health or any analytical field including Applied Mathematics and Statistics, Finance, Health Care Management or related field.
Five to eight years’ managed care experience, two to three years’ experience in any analytic field.
Understanding of CAHPS measures and knowledge of HEDIS, QARR, Star reporting processes strongly preferred
Knowledge of quality improvement activities such as PDSA preferred.
Must have strong working knowledge of Microsoft Office applications including Word, Excel, Access and PowerPoint.
Experience with relational databases applications (MS Access, SAS, R) strongly preferred. Ability to lead others on large scale, complex, highly visible projects.
Solid analytical skills paired with strong attention to detail. Uses rigorous logic and methods to solve difficult problems with effective solutions.
Integrity and Trust