Director, Network Analytics and Evaluation
This position is responsible for leading the development, programmatic oversight and execution of network analytics, quality improvement, evaluation, and HEDIS strategy and activity across the organization. Time is focused on business group oversight, with secondary time on enterprise-wide engagement. Primary duties include operational planning and oversight, as well as resource, relationship, and people management. This position provides input into strategic plans for the broader organization.
Provides direction and unit oversight to the Value-Based Payment (VBP), Medicare and CCO Metrics, Medicare Stars, HEDIS, and evaluation teams to facilitate high quality care and clinical performance and health outcomes targets for members.
Oversees HEDIS data review and submission process.
Collaborates with Network and line of business leadership on development and operation of value-based payment programs.
Oversees the development and execution of initiatives and collaboration to improve network outcomes for common needs across lines of business.
Effectively oversees the execution of program evaluation strategies relevant to regional priorities in collaboration with other CareOregon departments.
Ensures program compliance and the development and implementation of policies and procedures that are compliant with Medicaid/Medicare regulations, Oregon Health Authority (OHA) as well as NCQA and HEDIS requirements.
Ensures all applicable Medicaid/Medicare regulations are understood and operationalized.
Provides oversight for development of programmatic guidelines, and ensures guidelines are followed.
Oversees ongoing analysis of data relevant to the functional areas of the unit; identifies opportunities for improvement and participates in their development and implementation, including process improvement initiatives.
Provides strategic support to CareOregon and Network teams to develop, utilize and regularly monitor measures/metrics to improve the program’s effectiveness and efficiency of work processes.
Acts as a resource to program supervisors.
Participates in the development of vision, goals, and strategic plans for the Network team.
Leads the development and execution of network quality improvement analysis and evaluation strategies within functional teams to support regional and organizational goals including but not limited to:
Provider data-sharing strategies,
Delivery system incentive strategies, and
Value-based payment methodologies
Develops strategies and tools to provide all lines of business with performance information to inform clinical quality initiatives.
Provides input into strategic plans for the organization.
Develops annual program goals that align with organizational strategic goals in collaboration with the Vice President of Network Relations and Quality Improvement.
Develops short and long-term plans and policies; oversees the development and execution of standard operating procedures.
Maintains a business unit view while establishing department priorities, being cognizant of broader business unit and organizational impacts.
Recommends budgets in alignment with short- and long-term plans.
Manages resources to ensure priorities are accomplished.
Approves resource allocations within budget, including people, finances, and timelines; make decisions on exceptions.
Leads effective communication system for work group(s), ensuring a collaborative culture.
Builds and ensures effective relationships across internal teams and external organizations for current or future integration.
Partners with internal leaders and managers in identifying improvement plans and processes.
Provides department wide support and oversight in organizational alignment work with lines of business and regional teams; act as key liaison with other teams.
Provides strategic partnership and support to lines of business to implement operational and clinical initiatives that assure that CareOregon meets all provider network-based quality improvement targets, performance improvement programs, and regulatory deliverables.
Represents CareOregon in external meetings and functions, providing productive leadership presence and effectiveness.
Acts as CareOregon and Network delegate in relevant state and national committees and ensure our programs and policies consider the evolving landscape.
Directs team(s) and establishes team direction and goals in alignment with the organizational mission, vision, and values.
Identifies work and staffing models; recruits, hires, and oversees a team to meet work needs, using an equity, diversity, and inclusion lens.
Identifies department priorities; ensures employees have information and resources to meet job expectations.
Leads the development, communication, and oversight of team and individual goals; ensures goals, expectations, and standards are clearly understood by staff.
Manages, coaches, motivates, and guides employees; promotes employee development.
Incorporates guidance from CareOregon equity tools into people leadership, planning, operations, evaluation, budgeting, resource allocation, and decision making.
Ensures team adheres to department and organizational standards, policies, and procedures.
Evaluates employee performance and provides regular feedback to support success; recognizes strong performance and addresses performance gaps and accountability (corrective action).
Performs supervisory tasks in collaboration with Human Resources as needed.
Perform work in alignment with the organization’s mission, vision, and values.
Support the organization’s commitment to equity, diversity, and inclusion by fostering a culture of open mindedness, cultural awareness, compassion, and respect for all individuals.
Strive to meet annual business goals in support the organization’s strategic goals.
Adhere to the organization’s policies, procedures, and other relevant compliance needs.
Perform other duties as needed.
Knowledge, Skills and Abilities Required
Strong knowledge of health plan regulatory requirements of Medicaid and Medicare managed care
Advanced knowledge of principles and statistical methodologies for program assessment and evaluation
Working knowledge of health care quality reporting programs, such as Medicare Stars and HEDIS
Understanding of value-based payment concepts and related measurement strategies
Leadership effectiveness and ability to design and implement constructive change
Ability to balance strategic and operational thinking
Ability to effectively convey business unit goals and plans ensuring integration into strategic plans and initiatives
Ability to develop, test, and evaluate programmatic initiatives
Ability to manage multiple priorities and complex initiatives; ability to delegate as deemed appropriate
Analytical capability and working knowledge of Microsoft Office programs, Tableau, or other statistical software
Skilled in budget management and oversight
Ability to communicate effectively, both verbally and in writing, including strong presentation skills
Skilled in negotiation and ability to build consensus
Ability to build and maintain professional relationships with business, community and internal management groups
Ability to work in an environment with diverse individuals and groups
Ability to mentor individual growth
Physical Skills and Abilities Required
Lifting/Carrying up to 10 Pounds
Pushing/Pulling up to 0 Pounds
Pinching/Retrieving Small Objects
More than 6 hours/day
More than 6 hours/day
More than 6 hours/day
More than 6 hours/day
More than 6 hours/day
Ability to operate a motorized vehicle
Cognitive and Other Skills and Abilities
Ability to focus on and comprehend information, learn new skills and abilities, assess a situation and seek or determine appropriate resolution, accept managerial direction and feedback, and tolerate and manage stress.
Education and/or Experience
Minimum 10 years’ related experience, including 7 years’ experience in quality improvement analytics, clinical informatics, evaluation, or related areas
Minimum 4 years’ supervisory experience
Experience with the Oregon Health Plan (OHP) benefit and the Oregon Health Authority (OHA) and the Centers for Medicare and Medicaid Services (CMS) rules and regulations
Environment: This position’s primary responsibilities typically take place in the following environment(s) (check all that apply on a regular basis):
☒ Inside/office ☐ Clinics/health facilities ☐ Member homes
Travel: This position may include occasional required or optional travel outside of the workplace, in which the employee’s personal vehicle, local transit, or other means of transportation may be used.
Equipment: General office equipment and/or mobile technology
Candidates of color are strongly encouraged to apply. CareOregon is committed to building a linguistically and culturally diverse and inclusive work environment
Veterans are strongly encouraged to apply.
Equal opportunity employer. This company considers all candidates regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status.Position Description »