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Clinical Reporting, Professional, Quality Initiatives Lead

Headquarters Office, Schenectady, New York, United States of America, Rochester Office, Rochester, New York, United States of America, Tarrytown Office, Tarrytown, New York, United States of America Req #213
Tuesday, August 6, 2019
Be a part of the transformation at MVP Health Care®. MVP Health Care is a nationally-recognized, regional not-for-profit health insurer. We care for more than 700,000 members across New York and Vermont and are powered by the ideas and energy of more than 1,700 employees. We employ talented people  with diverse backgrounds and experience—tech people, numbers people, even people people—to make health insurance more convenient, more supportive, and more personal. If you’re ready to join a thriving, mission-driven company where you can create your own opportunities—it’s time to make a healthy career move to MVP.

Status: Full-time, Exempt: Yes


Obtain and analyze monthly data required for NCQA standards, HEDIS/QARR measures and CMS Star quality ratings. Interpret these findings, identify barriers, and propose methods for improvement. Collaborate and communicate with internal departments to implement effective interventions that support NCQA health plan accreditation and the increased performance of HEDIS/QARR/STARS rates. Develop documentation and reporting tools to allow QI to track the progress and success of our outreach and interventions at both the
member and provider level. Perform as an active member of all quality meetings that pertain to increasing quality results. Performs other duties as assigned by management.

Provider Initiatives – 

• Develop Provider Incentive programs and collateral, such as Medicaid RQI and Marketplace Incentive. 

• Coordinates the distribution of Quality data to our provider community, working collaboratively with Provider relations, Provider Engagement and Networks.

• Develops and implements a system of communications and tracking that ensures all physicians have access to reports. 

• Influences provider practice patterns in a positive manner for all lines of business to improve the quality of care and encourage appropriate care to be delivered in the appropriate setting.

Member Initiatives –

• Develop Member Incentive programs and collateral, obtain NYS approval when necessary.

• Coordinate member call campaigns, mailings and incentive programs to support QI outreach and interventions.

• Work collaboratively with Marketing & Communications, Community Engagement and Community Health Promotions to develop opportunities for member education and improving the health of our member community. 

POSITION QUALIFICATIONS

Minimum Education:

Bachelor's degree or equivalent combination of education and experience in a managed care environment.


Minimum Experience:

Minimum of three years health care or managed care experience is required.

Minimum of two years mental health or substance abuse experience is required. 

Experience with HEDIS/QARR/STARS. 

Experience working within a quality improvement role is strongly preferred.  

Required Skills: 

• Excellent analytical skills are required. Takes action to solve problems and move situations to closure while demonstrating sound judgment and a clear understanding of issues. 

• Demonstrated experience with and proficiency in the management of data, reports and database. 

• Superior attention to detail and strong project management skills are required. Prioritizes various competing tasks and performs them efficiently according to their urgency. 

• Adapts and works effectively with individuals or groups. Works comfortably during changing circumstances. Adapts approach as the requirements of a situation change. Changes or easily accepts changes in job requirements.

• Excellent interpersonal and communication (telephone, verbal and written) skills required.

• High proficiency with Microsoft Office Suite.

• Some travel including periodic overnight stays will be required.

Preferred Skills:

• Experience with Macess, Facets and/or Care Radius is a plus.




MVP Health Care is an Affirmative Action/Equal Opportunity Employer (PDF). We recruit, employ, train, compensate, and promote without regard to race, religion, creed, color, national origin, age, gender, sexual orientation, marital status, disability, genetic information, veteran status, or any other basis, e.g., Pay Transparency (PDF), protected by applicable federal, state or local law. Any person with a disability needing special accommodations to the application process, please contact Human Resources at hr@mvphealthcare.com.

Other details

  • Job Family Medical Management/Clinical
  • Pay Type Salary
  • Headquarters Office, Schenectady, New York, United States of America
  • Rochester Office, Rochester, New York, United States of America
  • Tarrytown Office, Tarrytown, New York, United States of America