Value-Based Payment and Medicare Analytics Manager

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Job Summary
This position manages the operations, projects and planning for analytics teams focused on Medicare Stars, HEDIS, value-based payment, and other data-sharing and/or quality improvement programs. These teams are responsible for analyzing, monitoring, reporting, and providing technical collaboration on clinical quality improvement activities related to these programs. This position monitors staffing and resource needs, develops staff members, recommends policies, and leads process improvement efforts. Additionally, this position works with department leadership on plan-wide quality improvement and data strategy activities. The position assists in developing a long-term plan for analytics and evaluation activities to support the needs of the organization, including enterprise data and analytics solutions.

Essential Responsibilities

Technical Leadership

Lead analytics activities for the organization related to Medicare Stars, HEDIS, and value-based payment.
Oversee the ongoing analysis of data relevant to the functional areas of the unit.
Identify opportunities and develop plans for improvement.
Provide leadership in quality, cost, value-based payment programs, evaluation, and regulatory reporting.
Establish department processes and monitor workflow and resource needs.
Study and analyze tables, graphs, charts and report results in a variety of formats.
Plan, organize, manage and monitor work projects.
Ensure unit work is integrated and performing in coordination with other relevant CareOregon departments.
Keep abreast of best practices in clinical quality measurement and incorporate these practices into the team’s work.
Participate in CareOregon, OHA, or national workgroup meetings and committees related to clinical quality improvement and data analysis as needed.
Represent CareOregon at internal and external partner meetings.

Planning

Develop and implement policies and procedures that are compliant with OHA and CMS regulations as well as NCQA.
Lead the planning, design, and implementation of new analytic strategies and methodologies.
Assist the Director with short-term and long-term analytics planning.
Provide recommendations to senior management on strategies for meeting performance goals.
Assist management with team budget development and monitoring.

Supervision

Manages team(s) and recommends team direction and goals in alignment with the organizational mission, vision, and values.
Identifies work and staffing needs to meet work expectations; recruits and hires, using an equity, diversity, and inclusion lens.
Plans, organizes, schedules, and monitors work; 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.
Trains, supervises, motivates, and coaches employees; provides support toward employee development.
Incorporates guidance from CareOregon equity tools into people leadership, planning, operations, evaluation, 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.

Organizational Responsibilities
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
Experience working with complex data sets
Strong understanding of health care quality reporting programs, specifically Medicare Stars and HEDIS
Strong understanding of best practices in data visualization
Strong understanding of value-based payment concepts and related measurement strategies
Knowledge of SQL coding
Knowledge of managed care concepts and principles and basic health plan operations
Knowledge of health plan regulatory reporting requirements of Medicaid and Medicare managed care, specifically Medicare STARS measures
Ability to operationalize quality improvement and process improvement concepts, principles, and practices
Excellent analytical, problem solving and decision-making skills
Proficient user of Microsoft Office programs, Tableau, or other statistical software
Ability to provide leadership to groups of people and as the implementation of projects
Ability to manage multiple tasks and projects and to delegate as deemed appropriate
Excellent reading, oral and written communication and interpersonal skills
Ability to effectively collaborate with leadership.
Ability to work independently
Ability to work in an environment with diverse individuals and groups
Ability to mentor individual growth
Ability to support and comply with organizational policies, procedures and guidelines
High degree of initiative and motivation

Physical Skills and Abilities Required

Lifting/Carrying up to 10 Pounds

Pushing/Pulling up to 0 Pounds

Pinching/Retrieving Small Objects

Crouching/Crawling

Reaching

Climbing Stairs

Repetitive Finger/Wrist/Elbow/

Shoulder/Neck Movement

0 hours/day

0 hours/day

0 hours/day

0 hours/day

0 hours/day

0 hours/day

More than 6 hours/day

Standing

Walking

Sitting

Bending

Seeing

Reading

Hearing

Speaking Clearly

0 hours/day

0 hours/day

More than 6 hours/day

0 hours/day

More than 6 hours/day

More than 6 hours/day

More than 6 hours/day

More than 6 hours/day

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

Required:

Minimum 5 years’ progressive experience in a quality improvement, analytics, research, or related work
Minimum 2 years’ experience in a supervisory position
Bachelor’s degree in Business, Analytics, Healthcare, or related field
Preferred:

Experience working with the Oregon Health Plan (OHP) benefit, the Oregon Health Authority (OHA) and/or the Centers for Medicare and Medicaid Services (CMS) rules and regulations

Working Conditions

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

☐ Other_________________________________________

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
Hazards: n/a
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.

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