Healthfirst is a provider-sponsored health insurance company that serves more than 1.2 million members in downstate New York. With more than 4,000 employees, a network of nearly 30,000 providers, and revenues in excess of $8.6 billion, Healthfirst is one of the largest health plans in the New York City area.
The Manager of Quality of Quality Ratings leads organizational efforts to improve Healthfirst's performance on 2 or more quality ratings programs. Current quality ratings programs include Medicare Stars, Medicaid Quality Incentive, Qualified Health Plan Quality Ratings System, Managed Long Term Care (MLTC) Incentive, and Fully Integrated Dual Advantage (FIDA) quality withhold.
Duties and Responsibilities:
Develops and refines short- and long-term strategies to improve performance on quality ratings programs that are aligned with Healthfirst’s overall corporate strategy. Monitors status of current and projected performance on Quality Ratings and reports out to senior leadership and the health plan’s Quality Committees.
Collaborates with colleagues across the organization to identify and vet data-driven opportunities to improve performance on quality ratings programs. Creates, manages and evaluates project plans and work plans. Reviews data to evaluate impact of interventions and to drive continuous performance improvement.
Acts as subject matter expert on assigned Healthfirst Quality Ratings programs, including program and measure specification proposals/changes. Communicates with business owners and senior leaders to provide information on proposed changes and their impact to Healthfirst.
Drafts and refines comments to regulatory agencies, measurement bodies, coalitions, and other industry groups about Quality Ratings programs, seeking input from stakeholders across the organization. Collaborates with external groups and experts about Quality Ratings program changes, best practices, and other relevant topics.
Champions culture of quality by supporting workgroups in improving processes and operations, researching and communicating industry best practices, and recognizing teams and individuals for their contributions to quality.
Effectively manages staff and team performance, supporting their professional growth and building the next generation of Healthfirst leadership.
Healthfirst is an Equal Opportunity Employer and does not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity or expression, veterans, disability status or any other characteristic protected by law.
Healthcare experience associated with population health outcomes, quality improvement, or policy.
Proficiency in Microsoft Office – daily use of Outlook, the ability to create polished Power Point presentations for a range of audiences, intermediate to advanced Excel skills, intermediate Word skills.
Excellent written and oral communication skills. Experience presenting senior leaders within or outside of one’s place of employment.
Experience analyzing data and making data-driven recommendations for quality improvement.
Experience leading cross-functional work groups.
Master's degree in Public Health or Business Administration.
Experience working with a hospital, health insurance company, or healthcare focused government agency or non-profit (e.g. DOH).
Strong leadership skills with the ability to manage up and across multiple departments of a large organization.
Experience with complex and high-impact projects and programs. Proven ability to handle multiple projects simultaneously and adjust to changes quickly while meeting deadlines.
Strong problem solving and effective decision making skills. Ability to exercise sound judgment.
Ability to work independently in a fast paced environment
Supervisory or team lead experience. Ability to train, coach and mentor staff.
Healthfirst® is a not-for-profit health insurance company sponsored by some of the most prestigious hospitals and healthcare systems in New York. It serves close to 1.2 million members in New York City and in Long Island through government-sponsored programs including Child Health Plus, Medicaid, Medicare Advantage, and Managed Long Term Care, as well as through private health plans including Heal...thfirst Leaf and Qualified Health Plans, offered on NY State of Health, The Official Health Plan Marketplace.
Established in 1993, Healthfirst was an early pioneer in aligning incentives and goals with the provider delivery system through comprehensive value-based payment approaches. Today, with its provider partners, it is at the forefront of healthcare reform as it continues to build upon its collaborative model to offer the best in quality and member-centric care. It is a 4-Star Medicare Advantage plan and the only health plan in its market with 5 Stars for quality on the NY State of Hea