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Manager, Quality Data

Job Category:  Administrative, HR, Business Professionals
Department:  Quality Performance Management
Location: 

Los Angeles, CA, US, 90017

Position Type:  Full Time
Requisition ID:  8601

 

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.

As a condition of employment, L.A. Care requires a COVID-19 vaccine. This requirement includes our remote workforce. If you would like to request an exemption, L.A. Care has implemented a process to consider exemptions, for documented medical conditions and sincerely held religious beliefs. L.A. Care will review all exemption requests prior to proceeding with the recruitment process.

Job Summary

The Manager of Quality Data is an important role on the quality data team. This position will work closely with technical, clinical, and compliance personnel to ensure accurate and timely delivery of Healthcare Effectiveness Data and Information Set (HEDIS) and Survey data to regulatory entities, partners and other stakeholders. This position plays a key role in optimizing data procurement and streamlining operational processes for Extract, Transform, and Load (ETL). The manager in this role will be responsible for the performance of the HEDIS data analysts which includes Senior Data Analyst, Data Analysts and Survey Analysts. This position is responsible for data process regarding HEDIS and Surveys, including Member and Provider experience, Health Outcomes and others which together are used for National Committee for Quality Assurance (NCQA) accreditation and L.A. Care provider, group and plan partner performance management, which are high profile projects for L.A. Care. This position will create and maintains policies and procedures relevant to HEDIS and Survey data process involving rate calculations, reports and quality assurance checkpoints which may involve other L.A. Care teams. This position will also coordinates with vendors, provider groups and plan partners to maximize data completeness, analyzing quality data results to identify improvement opportunities. In addition to these responsibilities, this position works with product evaluation, reviews and manages the budget, accounts for variations, works with the legal advisor on review and vetting of proposals and contracts, participates in compliance audits such as State Department of Health Care Services (DHCS), HEDIS, NCQA and others as needed and will contribute to executive summary documentation and presentations on outcomes. The Manager participates in Quality Improvement initiatives and committee meetings. The Manager in this role will have a pivotal role in the success of L.A. Care as public reporting and data process efficiency are of utmost importance.  

Duties

Manages the HEDIS and Survey Projects: Updates internal policies and procedures that pertain to functions related to data process, data collection, and Health Insurance Portability and Accountability Act (HIPAA) compliance. Present to groups as needed. 

Staff support and administration; Works with staff to set up incentive goals, and work metrics; Monitors activity to assure staff are engaged; Works with the technical staff to develop databases for data capture and reporting; Conducts verbal or written counseling, writes performance improvement plans, and  resolves issues impacting productivity.

Works with and presents to Plan Partners and provider groups to optimize data quality and completeness.

Works with the technical staff to produce and assure the delivery of reports for submissions required by NCQA, Centers for Medicare and Medicaid Services (CMS), Managed Risk Medical Insurance Board (MRMIB), and other regulatory or accreditation agencies.

Resolves issues impacting delays in timelines, staffing, and/or production.

Initiates and participates in performance/quality improvement initiatives and workgroups.

Sets work standards and monitors production as indicated by the project plan.

Oversight of data vendor services.

Perform other duties as assigned.

Education Required

Bachelor's Degree in Mathematics or Economics
In lieu of degree, equivalent education and/or experience may be considered.

Education Preferred

Experience

Required:
At least 6-8 years of clinical outcomes review and quality data experience with strong skills in data validation.

At least 3-5 years of supervisory/management experience with a good skill to communicate with technical staff in a NCQA accredited health plan. 

At least 3 years of experience with HEDIS  and Surveys for example, Consumer Assessment of Healthcare Providers and Systems (CAHPS),  Consumer Assessment of Healthcare Providers and Systems Clinician & Group Survey (CG-CAHPS), Consumer Assessment of Healthcare Providers and Systems Medicare Advantage and Prescription Drug Plan (CAHPS- MAPD), Qualified Health Plan Enrollee Experience Survey (QHP-EES), Health outcome Survey (HOS), etc.
 
Preferred:

5 years experience in advanced programming skills working with data types such as membership, provider, claims and encounters 
 

 

Skills

Required:
Good skill to communicate with technical staff in a NCQA accredited health plan. 

Advanced programming skills working with data types such as membership, provider, claims and encounters.

Working knowledge of MS Access, Excel, and Word software.  

Able to manage project timelines, requested deliverables and developing and maintaining prioritization thereof.

 

Licenses/Certifications Required

Licenses/Certifications Preferred

Healthcare Effectiveness Data and Information Set (HEDIS) Compliance Auditor
Registered Nurse (RN) - Active, current and unrestricted California License
Registered Health Information Administrator (RHIA) - active and valid
Registered Health Information Technician (RHIT)

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)

 

At L.A. Care, we value our team members’ safety. In order to keep our work locations safe, each employee is required to self-screen for symptoms prior to entering any L.A. Care location each day. L.A. Care and all of its staff are required to comply with all state and local masking orders. Therefore, when on-site at any L.A. Care location, employees are expected to wear a mask in areas where physical distancing cannot be managed.


Nearest Major Market: Los Angeles

Job Segment: Nursing, Registered Nurse, Claims, Medicare, Performance Management, Healthcare, Insurance, Human Resources

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