Director, Quality Performance Informatics

Job Category:  Management/Executive
Department:  Quality Performance Management
Location: 

Los Angeles, CA, US, 90017

Position Type:  Full Time
Requisition ID:  5014

 

Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members in five health plans, we make sure our members get the right care at the right place at the right time.

Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.

Job Summary


The Director, Quality Perfornance Informatics is responsible for overseeing all standardized clinical performance measurement, analysis, reporting and optimization of processes. The director develops strategies and solutions for rate generation, analysis and reporting of standardized performance metrics related to clinical care (HEDIS), provider and member satisfaction (CAHPS- HP, MAPD and CG and QHP-EES), access to care, and provides analytic and decision support to the organization through qualitative and quantitative analysis of HEDIS/CAHPS and related reports. The director is responsible for strategies and solutions for optimizing completeness and timeliness of data for both electronic data and file procurement and medical records and oversees the successful completion of chart retrieval, abstraction, medical record review and validation (MRRV). The director oversees all processes for accurately reporting HEDIS, CAHPS ro regulatory bodies, related member/provider surveys, retrospective and prospective VIIP+P4P opportunity reports/analysis and all operational aspects of the HEDIS/CAHPS compliance audits.  The director works closely with teams within QI and L.A. Care plan partners and PPGs; L.A. Care departments: I.T., Risk Adjustment, EDSA, Medicare Operations, and other departments, to identify opportunities for operational synergies to improve data capture and quality, and to provide technical and analytical support for clinical quality projects. These include opportunity identification, performance monitoring, analytical reporting, program design, impact analysis, and program evaluation. In addition, the director develops and manages the operational budget, works with Procurement and Legal on contracts and RFPs. The director initiates and champions quality improvement projects to improve State auto-assignment and National Committee for Quality Assurance (NCQA) accreditation scores. The success of this leadership role results in improved quality ratings, health plan accreditation status, continued success in auto-assignment enrollment and reduced administrative costs. In addition to management and oversight of vendor entities, the director oversees a team of professional employees with extensive knowledge of clinical quality measurement methodology, HEDIS/CAHPS production, medical record review, survey and study design methodologies.

Duties


Oversee and direct the annual HEDIS, CAHPS, and Provider Survey reporting, analysis, compliance audit cycle for L.A. Care and Plan Partners, Kaiser, ABC, Care 1st. Execute vendor scope of work and oversee performance for: (1) HEDIS rules software engine and associated data quality, completeness, validation and analytics; (2) chart retrieval and abstraction; (3) lab data.  Establish close collaboration/communication with Plan Partners and provider groups to monitor and ensure successful completion of the annual reporting cycle.  Work with I.T., vendors, and technical staff to ensure compliance to quality reporting requirements in accordance with DHCS, NCQA, CMS, HHS, Covered California and other regulatory and accrediting agencies on standardized performance metrics. Develop and monitor timelines and production schedules to ensure adherence to regulatory due dates. Resolve issues impacting delays in timelines, staffing, and/or production.  Establish performance standards for vendors, staff and monitor progress toward attaining established goals for State auto-assignment, NCQA accreditation, and Cal Medi-Connect MMP Quality Performance Withholds. Identify and implement technical solutions to improve workflow and analytics, and reduce administrative costs. Develop and implement strategies to better engage provider/network partners on improving member care and experience/satisfaction with service. Ensure that plan partners and provider/network partners are knowledgeable and familiar with key aspects of LA Care strategies and goals for continuous improvement on State Auto-Assignment and NCQA/CMS/HHS quality performance standards and benchmarks. Oversee and ensure successful completion of all aspects of the HEDIS compliance audit.

 

Data Analytics and Reporting: Develop and deliver actionable analytics across L.A. Care, Plan Partners, PPGs, and practitioners. Direct creation and revisionof scorecards and dashboards to monitor HEDIS, CAHPS and related performance to facilitate data-driven decision making and timely implementation of initiatives and interventions to improve care and coordination of care throughout the L.A. Care system: LAC internal operations, plan partners, PPGs, ancillary service providers, vendors.

 


Design, implement and champion HEDIS/CAHPS/Access related quality improvement activities: Recommend strategies for improving care and timely health data exchange with plan partners, PPGs, practitioners, and members.  Collaborate with plan partners, PPGs, and L.A. Care departments to leverage programs and initiatives that have had quantifiable impact and return on investment. Evaluate impact of HEDIS/CAHPS and other interventions and strategies. Analyze trends and disparities; identify opportunities to centralize and aggregate data sources within L.A. Care and elsewhere to improve robust data reporting and analytics. Communicate findings, barriers, and recommendations to leadership and business owners.
Implement annual HEDIS/CAHPS outreach targeting practitioner offices to improve engagement on quality performance metrics and follow through and monitor impact.

Education Required
Bachelor's Degree
In lieu of degree, equivalent education and/or experience may be considered.
Education Preferred
Doctor of Pharmacy (Pharm.D)
Experience

Required:
At least 7 years experience in a health plan specializing in healthcare informatics, QI initiatives and analytics, HEDIS, Risk Adjustment, and Stars with at least 5-7 years of supervisory/management experience.

 

Experience in implementing initiatives to improve analytics and operational efficiencies.

Skills


Required:
Must have proven track record of success in HEDIS and Stars Performance Improvement in data generation, reporting, analysis, chart retrieval/abstraction and expert knowledge of MRR validation process.

 

Training in intermediate to advanced level Excel, MS Access, SAS; HEDIS; and other analytic software and/or at least 3-5 years of management of technical/analytics staff and programmers.

 

Excellent written and verbal communication skills.

 

Strong management skills.

 

Strong analytical skills.

 

Meticulous attention to details and processes.

 

Licenses/Certifications Required
Licenses/Certifications Preferred
Required Training
Additional Information

 

L.A. Care offers a wide range of benefits including

  • Paid Time Off (PTO)
  • Tuition Reimbursement
  • Retirement Plans
  • Medical, Dental and Vision
  • Wellness Program
  • Volunteer Time Off (VTO)


Nearest Major Market: Los Angeles

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