Provider Program Quality & Integration Consultant III

Job Description:

Summary:

The Provider Program Quality & Integration Consultant facilitates the development and effective implementation of quality and incentive programs and contracts. This work directly impacts the Excellus clinical provider network and member populations. As an individual contributor this role is a combination of researcher consultant strategist and analyst that facilitates the successful execution of business strategy.

The incumbent builds vision consensus and commitment among stakeholders such as physicians nurses health system executives quality leadership vendor partner leadership and community leaders using industry measurement methodologies clinical best practice and empirically sourced change management practices. This position serves as the subject matter expert in all aspects of quality improvement measurement and network implementation to increase efficiency and productivity while reducing waste and costs.

Essential Accountabilities:

Level I

Develops negotiates administers and maintains contracted quality improvement programs:

Health plan quality goal and national measurement SME including CMS HEDIS QARR STAR CAHPS measures.

Data mining and analysis ability to formulate solutions and narrate program value stories.

Process improvement healthcare quality trend and project leadership SME.

Locates and submits clinical evidence/best practice associated with program development and implementation to inform network and vendor proposals.

Evaluates and reports quality program statuses and outcomes to determine impact of interventions using direct and proxy measurement and validation.

Develops process standardization and workflow recommendations for quality programs and contracts in development.

Supports and executes network and vendor programs which improve the quality safety and accessibility of care while lowering costs through implementation of strategic initiatives.

Ensures program alignment with organizational goals and existing provider network relationships.

Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies mission and values adhering to the Corporate Code of Conduct and leading to the Lifetime Way values and beliefs.

Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures.

Regular and reliable attendance is expected and required.

Performs other functions as assigned by management.

Level II (in addition to Level I Accountabilities)

Manages network and vendor engagements including vendor selection contract negotiation contract process oversight and vendor implementation with other key business areas as appropriate.

Provides oversight and direction in managing day to day operations of complex projects and programs including associated reporting while remaining compliant with mandates.

Independently develops novel program proposals focused on quality improvement and cost savings utilizing network relationships and competitive market analysis.

Provides recommendations builds collaboration and focuses team efforts through regular presentation. Takes the initiative to interface with matrixed groups related to program development and implementation.

Takes a systematic delivery view of the portfolio: identifying developing and managing cross-dependent projects to increase efficiency and effectiveness while addressing barriers and risks.

Is a primary contact for matrixed implementation of initiatives including oversight of strategic programs that involve external organizations.

Educates mentors and coaches members of the program team throughout the course of development and implementation to ensure the goals of the program are realized in alignment with its strategic mission and vision.

Works closely with those accountable for driving clinical changes from both the delivery system and the Health plan to obtain feedback regarding the viability of programs and provider needs.

Participates in critical activities such as strategic planning and thought leadership at a departmental cross functional and organization level.

Minimum Qualifications:

NOTE: We include multiple levels of classification differentiated by demonstrated knowledge skills and the ability to manage increasingly independent and/or complex assignments broader responsibility additional decision making and in some cases becoming a resource to addition to using this differentiated approach to place new hires it also provides guideposts for employee development and promotional opportunities.

All Levels

Minimum of 5 years of related work experience.

Bachelors degree in Nursing Business or Healthcare Administration Analytics Project Management or related fields preferred.

Applied knowledge of quality improvement accreditation or regulatory compliance.

Demonstrated quality principles proficiency in problem solving and quality tools/techniques.

Strong communication skills required including ability to effectively communicate verbally and in writing internally and externally and across the organization and all levels of management.

Strong facilitation skills.

Strong understanding and application of vendor management skills.

Skilled speaker and presenter experienced in defining socializing and sustaining change across diverse groups.

Very strong analytical and business process development skills.

Demonstrated experience in project leadership or principles such as Lean Six Sigma CPC process mapping tests of change or PDSA cycles.

Demonstrated experience communicating with senior management in various formats informal discussions written reports scheduled meetings and executive level presentations.

Knowledge and experience working in the healthcare health insurance or similar industry.

Level II (in addition to Level I Qualifications)

Three years of additional related experience.

PMI Certification/ PMP Certification or other project management certification preferred.

Demonstrated knowledge of network and vendor experience in relation to quality.

Prior program implementation experience preferred.

Prior network and product experience.

Physical Requirements:

Ability to work while sitting and/or standing at a workstation viewing a computer and using a keyboard mouse and/or phone for three (3) or more hours at a time.

Ability to travel across the Health Plan service region for meetings and/or trainings as needed.

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In support of the Americans with Disabilities Act this job description lists only those responsibilities and qualifications deemed essential to the position.

Equal Opportunity Employer

Compensation Range(s):

Level I: Grade E3: Minimum $60410 - Maximum $106929

Level II: Grade E5: Minimum $71880 - Maximum $129384

The salary range indicated in this posting represents the minimum and maximum of the salary range for this position. Actual salary will vary depending on factors including but not limited to budget available prior experience knowledge skill and education as they relate to the positions minimum qualifications in addition to internal equity. The posted salary range reflects just one component of our total rewards package. Other components of the total rewards package may include participation in group health and/or dental insurance retirement plan wellness program paid time away from work and paid holidays.

Please note: The opportunity for remote work may be possible for all jobs posted by the Univera Healthcare Talent Acquisition team. This decision is made on a case-by-case basis.

All qualified applicants will receive consideration for employment without regard to race color religion sex sexual orientation gender identity national origin disability or status as a protected veteran.