Quality and Health Plan Relations Manager

Company:

Job Posting Location:

Job Title: ​

Job Description: ​

Essential Job Functions:

• Participate in Health Plan JOCs: Engage in Joint Operating Committees (JOCs) with health plans to review performance metrics, discuss improvement strategies, and address any concerns.
• Contracting Collaboration: Work closely with the contracting team on health plan contracted measures for new contracts and renewals, including managing incentives and penalties.
• Health Plan Communication: Communicate and track all cross market wide health plan updates and/or notices
• Health Plan Point of Contact for Rejections: Engage with health plans to work through review of submitted gap closure rejections
• Health Plan Incentive and Penalties: Work with multiple departments to ensure that the status of the markets are up to date and that the tools associated with tracking the information are correct
• Reporting and Presentations: Prepare detailed reports and presentations on quality performance and Star ratings for senior management, including actionable plans and recommendations.
• Lead Improvement Efforts: Head quality improvement initiatives through specialized subgroups.
• Best Practice Sharing: Identify and share best practices across markets as it relates to quality
• Quality Gap Reconciliation: Collaborate on activities related to reconciling quality gap submissions.
• Regulatory Updates: Stay informed about changes in regulations, healthcare quality measures, and industry best practices.
• Project Assistance: Assist and support the Director of Quality Performance with various projects as needed.
• Additional Duties: Perform other duties as assigned to meet the organization’s needs

Other Job Functions:

• Understand, adhere to, and implement the Company’s policies and procedures.
• Provide excellent customer services skills, including consistently displaying awareness and sensitivity to the needs of internal and/or external clients.  Proactively ensuring that these needs are met or exceeded.
• Take personal responsibility for personal growth including acquiring new skills, knowledge, and information.
• Engage in excellent communication which includes listening attentively and speaking professionally.
• Set and complete challenging goals.
• Demonstrate attention to detail and accuracy in work product.

Required Qualifications:

Minimum Experience:

• 5+ years prior experience in a health insurance or healthcare setting.
• Understanding of healthcare quality measures (e.g., HEDIS, CAHPS, STARS, CMS).
• Excellent oral and written communication skills.
• Strong relationship-building skills.
• Proficiency in Microsoft Office (Word, Excel, PowerPoint).

Education/Licensure:

• Bachelor’s degree in business administration, Healthcare Management, or a related field, or equivalent experience.

Location: ​

Pay Range: ​

Salary range shown is a guideline. Individual compensation packages can vary based on factors unique to each candidate, such as skill set, experience, and qualifications.