Program Specialist – Quality & Value-Based Care – PCP Quality – Southwestern Health Resources (SWHR)

Program Specialist – Quality & Value-Based Care

PCP Quality Department is looking for top skilled Quality & Value-Based Care Program Specialist. Is that you?

Work location: Southwestern Health Resources Headquarters, 1601/1603 Lyndon B. Johnson Freeway, Farmers Branch, TX 75234.

Work environment: PCP Quality Department.

Please note: The Program Specialist – Quality and Value-Based will be an employee of Southwestern Health Resources (SWHR). SWHR is a clinically integrated network formed by Texas Health Resources (THR) and University of Texas Southwestern Medical Center (UTSW).

Work hours:

• Full-time, 40 hours per week.
• Monday – Friday, Day shift.
• This is a Telework position, to be based in Dallas/Fort-Worth Metroplex.
• Require onsite workdays based on department business needs.
• In-person attendance required at department meetings, trainings and/or other department authorized activities, at the above-mentioned address or other locations as directed by the department management.

Organization Highlights

Southwestern Health Resources (SWHR) is a patient-centered, clinically integrated network of 31 hospital locations and more than 7000 physicians and clinicians caring for more than 790,000 patients across 16 counties in North Texas. Blending the strengths of Texas Health Resources and the University of Texas Southwestern Medical Center, SWHR offers an unmatched ability to connect individuals with a full spectrum of nationally preeminent, clinical care. SWHR is the parent of Care N’ Care Insurance Co., a leading regional Medicare Advantage health plan that serves North Texas seniors.

At SWHR, we believe healthcare can be more integrated, accessible and affordable for all. Our purpose: to build a better way to care, together. Our promise: to simplify and empower care, for good.

Here’s What You Need

Education

• Bachelor’s Degree required.

Experience

• Require 2 years’ experience in Medicare Advantage (MA), Centers for Medicare & Medicaid Services (CMS) Star ratings, clinical quality, healthcare quality improvement, or healthcare analytics experience; or any combination of experience which would provide an equivalent background.
• Require 2 years of Project/Program Coordinator experience, or, require 2 years’ experience and knowledge of Centers for Medicare & Medicaid Services (CMS) Star ratings.
• Highly prefer knowledge & experience in National Committee for Quality Assurance (NCQA), Healthcare Effectiveness Data and Information Set (HEDIS), Medicaid and Medicare.

Skills & Abilities

• Work requires ability to effectively coordinate multiple initiatives.
• Ability to work independently with minimal supervision.
• Ability to manage deadlines and handle multiple tasks simultaneously.
• Ability to exercise discretion and maintain accountability while working with member-identifiable health information.
• Work requires excellent oral and written communication skills.
• Work requires excellent organizational skills.
• Work requires strong analytical/problem solving skills.
• Work requires ability to prioritize and organize work to meet deadlines, as well as time management.
• Work requires demonstrated ability and skills with project management and quality improvement tools, such as Microsoft Project, Visio, Excel, SharePoint.
• Knowledge of NCQA, HEDIS, Medicaid and Medicare is preferred.
• Knowledge of STAR ratings is preferred.
• Ability to work independently with a detailed focus on Medicare Advantage technical specifications, program design, compliance regulations and other CMS sources to effectively manage Medicare Star ratings.

What You Will Do

Position Responsibilities

The Quality & Value-based Care Program Specialist is responsible for analyzing structured health plan and ACO contractual data from multiple sources, leading and managing performance monitoring and reporting, and researching and synthesizing opportunities for improvement to business stakeholders. This position will work with internal and external teams to meet contractual and regulatory deadlines.

Position Functions

Project Management

• Accountable for project management of SWHRs ACO and quality stars program. Responsibility includes providing support for internal and external services lines for quality improvement activities around quality measures data such as but not limited to HEDIS, HOS, CAHPS, Pharmacy, administrative measures and regulatory/contractual requirements.
• Monitors and reviews progress of quality goals and initiatives reporting any barriers, delays, or red flags to manager.
• Act as a liaison with the assigned technical analyst completing the report, the requesting department and/or stakeholder, and manage business reporting requirements and objectives to ensure that it meets the stakeholder’s needs.
• Build excellent relationships with service area leaders to work cross-functionally to collaborate on measure improvement. Organizes and documents meeting minutes and action items during Star-related meetings.
• Lead projects and initiatives designed to impact Stars rates, which will include coordinating activities with matrixed partners.
• Suggests the development and revision of operational policies and procedures, workflows, and communications (both internal and external) in support of SWHRs Stars Program.

Data Management

• Responsible for organizing and tracking health plan and ACO contractual data necessary for quality initiatives and monitors performance compared to market and national benchmarks.
• Develop reports to track and monitor quality metrics on regular cadence, reporting concerns or discrepancies to manager.
• Generate reports and analyses to support internal stakeholder needs including quality management, network management, sales, and other key functions. Analyses may incorporate multiple data sources, including, but not limited to: clinical gaps-in-care, member surveys, network and provider performance, operational data, etc.

Education Liaison

• Serve as a Star subject matter expert and liaison between functional areas to support data requests and analyses and ensure uniform and consistent information and information flow.
• Maintain subject matter expertise on regulatory requirements to support MA CMS Stars program, MIPS and direct contracting.
• Coordinate the development and branding of marketing materials.
• Work independently to address questions regarding quality reports from internal and external parties.
• Subject matter expert to understanding quality technical specifications related to HEDIS/ ECDS and or other regulatory/accreditation needs.

Other duties as assigned.

Why Southwestern Health Resources

As a Southwestern Health Resources employee, you’ll enjoy, comprehensive benefits, including a 401(k) with match; paid time off; competitive health insurance choices; healthcare and dependent care spending account options; wellness programs to keep you and your family healthy; tuition reimbursement; a student loan repayment program; and more.

• Additional perks of being an SWHR employee:
• Gain a sense of accomplishment by contributing to a teamwork environment.
• Positively impact patients’ quality of life.
• Receive excellent mentorship, comprehensive training and dedicated clinical and administrative leadership resources.
• Enjoy opportunities for growth.

Explore Southwestern Health Resources Careers for more information and to search all career opportunities.

Our Recruitment team invites you to contact us with any questions at [email protected]

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