Quality improvement specialist Jobs in Cleveland, OH

Medical Mutual employees must submit their applications through MySource.

This is a hybrid‐remote role based out of the Brooklyn, OH office, with the Director HEDIS & Quality Improvement Analytics expected to work onsite on four designated in‐office days each week.

Founded in 1934, Medical Mutual is the oldest and one of the largest health insurance companies based in Ohio. We provide peace of mind to more than 1.2 million members through our high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans.

Director HEDIS & Quality Improvement Analytics

Job Summary:

Directs operations and staff engaged in Healthcare Effectiveness Data and Information Set (HEDIS) and clinical quality improvement analytics and supplemental data functions. Ensures adherence to reporting requirements of the National Committee on Quality Assurance (NCQA), and regulatory agencies. Leverages and delivers clinical quality improvement management data and reporting that support the health plan's strategies, goals, and initiatives for all lines of business (Commercial, Marketplace, Medicare Advantage, and Stars).

Responsibilities:

• Directs the HEDIS annual submission process. Develops and manages work plans; establishes and ensures timelines are adhered to, assigns responsibilities, and monitors and reports progress to internal stakeholders.
• Directs and coordinates the preparation of the HEDIS roadmap including all data sources and exchanges with vendors and providers.
• Leads strategic planning based on reporting and year over year comparisons for continual process improvement of Stars and HEDIS scores and overall accreditation for all lines of business.
• Measures trends, discusses reasoning behind trend, and calls out any significant changes.
• Leads the process for defining operational improvements within the health plan based on HEDIS performance following the annual HEDIS audit.
• Builds relationships with internal and external customers. Communicates progress and results through presentations to key stakeholders, including senior leadership.
• Presents at Joint Operating Committee (JOC) meetings with Physicians and Administrative Health System leadership.
• Leads strategic projects related to the use of supplemental data (internal, external and in the vendor space) to enhance performance for all lines of business for HEDIS improvement results and overall HealthPlan scores.
• Enhances reporting for Member Assistance Program (MAP) members and other clinical areas to identify assigned staff to cases for tracking and care gap closure opportunities
• Collaborates with internal stakeholders to ensure data warehouse architecture development and utilization.
• Directs the supplemental data team responsible for Extraction, Transformation and Loading (ETL) including the design, building, testing, and maintaining of ETL jobs.
• Oversees the translation of functional ETL requirements into technical design elements to be utilized by internal teams for managing and maintaining supplemental data.
• Directs external client relationships with regards to supplemental data including providing technical specifications to clients (SFTP set-up, file layout, etc.), establishing a cadence for data submission, monitoring the processing of data files, and working with the client to improve the impact of supplemental data on HEDIS measures.
• Develops and maintains Value-Based Consulting (VBC) reporting to support the VBC contracting outcomes and team
• Participates in contracting calls with Provider groups to supply details on supplemental data files and care gap measures scores. Collaborates with provider groups key contacts to enhance the data files.
• Manages staff developing quality measurement analytics and reporting for internal use and regulatory submissions including staffing, training and development and performance management. Ensures deliverables are reliable, valid, and actionable.
• Performs other duties as assigned.

Qualifications:

Education and Experience:

• Bachelor's Degree in Business or Health Care Administration, Public Health, or a related field.
• Master's degree preferred.
• 8 years of experience in health plan or health care analytics which includes HEDIS and clinical quality improvement, 5 years of which is in a leadership capacity.

Professional Certification(s):

Technical Skills and Knowledge:

• Comprehensive knowledge of the end-to-end HEDIS cycle (e.g., abstraction, data submission, audit, etc.) and the ability to apply advanced concepts to Company operations.
• Expert knowledge of and proficiency with NCQA-certified HEDIS software.
• Extensive knowledge of NCQA and CMS measurement, reporting and regulatory requirements.
• Intermediate to advanced knowledge of and proficiency with analytic programming languages and data visualization tools, including SAS, SQL, Cognos, Tableau, and Microsoft Visual Studio.
• Familiarity with multiple data source formats, including delimited flat files, web services, and SharePoint list XML.

Medical Mutual is looking to grow our team! We truly value and respect the talents and abilities of all of our employees. That's why we offer an exceptional package that includes:

A Great Place to Work:

• We will provide the equipment you need for this role, including a laptop, monitors, keyboard, mouse and headset.
• Whether you are working remote or in the office, employees have access to on-site fitness centers at many locations, or a gym membership reimbursement when there is no Medical Mutual facility available. Enjoy the use of weights, cardio machines, locker rooms, classes and more.
• On-site cafeteria, serving hot breakfast and lunch, at the Brooklyn, OH headquarters.
• Discounts at many places in and around town, just for being a Medical Mutual team member.
• The opportunity to earn cash rewards for shopping with our customers.
• Business casual attire, including jeans.

Excellent Benefits and Compensation:

• Employee bonus program.
• 401(k) with company match up to 4% and an additional company contribution.
• Health Savings Account with a company matching contribution.
• Excellent medical, dental, vision, life and disability insurance — insurance is what we do best, and we make affordable coverage for our team a priority.
• Access to an Employee Assistance Program, which includes professional counseling, personal and professional coaching, self-help resources and assistance with work/life benefits.
• Company holidays and up to 16 PTO days during the first year of employment with options to carry over unused PTO time.
• After 120 days of service, parental leave for eligible employees who become parents through maternity, paternity or adoption.

An Investment in You:

• Career development programs and classes.
• Mentoring and coaching to help you advance in your career.
• Tuition reimbursement up to $5,250 per year, the IRS maximum.
• Diverse, inclusive and welcoming culture with Business Resource Groups.

About Medical Mutual:

Medical Mutual's status as a mutual company means we are owned by our policyholders, not stockholders, so we don't answer to Wall Street analysts or pay dividends to investors. Instead, we focus on developing products and services that allow us to better serve our customers and the communities around us.

There's a good chance you already know many of our Medical Mutual customers. As the official insurer of everything you love, we are trusted by businesses and nonprofit organizations throughout Ohio to provide high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement and individual plans. Our plans provide peace of mind to more than 1.2 million Ohioans.

We're not just one of the largest health insurance companies based in Ohio, we're also the longest running. Founded in 1934, we're proud of our rich history with the communities where we live and work.

We maintain a drug-free workplace and perform pre-employment substance abuse and nicotine testing.

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