Manager of Behavioral Health Quality

Position Overview

The Manager of Behavioral Health Quality defines and strategically formulates the organization's Quality Improvement (QT) strategy for Behavioral Health (BH) metrics. The position manages and leads a cross-functional team to design, implement and evaluate QI initiatives and/or data mining/research activities to improve quality performance as defined by NCQA, DOH, CMS and other regulatory bodies while working closely with the BH Care Management, Pharmacy, and other departments to ensure resources are properly allocated to address performance deficiencies in key metrics.

Scope of Role & Responsibilities

• Defines and strategically formulates MetroPlusHealth's member/provider Quality Improvement (QI) strategy for Behavioral Health (BH) metrics and supports the organizational goal to provide top-tier Behavioral Health services.
• Effectively and efficiently manages all QI strategy projects.
• Manages QI Specialists in the design, implementation, and evaluation of quality and process improvement projects required to support HEDIS/QARR and other regulatory projects.
• Oversees Clinical Outreach Specialist team to ensure high-risk members are engaged and connected to appropriate services.
• Drives data analytics efforts to identify improvement areas, understand marketplace and member/provider behaviors, perform root-cause analysis, and evaluate program effectiveness for BH metrics.
• Able to provide innovative solutions to critical problems and foster a like-minded approach amongst direct reports.
• Identifies industry trends to ensure QI strategy keeps pace with planned or expected changes to state/federal quality reporting programs.
• Key player in developing member and provider incentives for BH metrics.
• Aligns internal/external action plans and workstreams with the organization's QI strategy.
• Evaluates effectiveness of such programs and improves as needed.
• Drives the provider strategy for improving quality performance in BH metrics.
• Conducts meetings with high-volume high-impact provider groups, shares performance data, and collaborates on performance improvement plans.
• Assists in establishing linkages between inpatient and outpatient BH care across BH and medical providers.
• Develops tools for and supports physicians, provider groups, etc. in addressing quality gaps-in-care and drives healthy outcomes for specific diseases.
• PARTNERS WITH THE PHYSICIANS, PROVIDER GROUPS, ETC. TO ENSURE DATA INTEGRITY/COMPLETENESS PERTAINING TO RENDERED SERVICES.
• CREATES ELECTRONIC DATA STREAMS AS NEEDED.
• MONITORS AND MANAGES QUALITY AND PERFORMANCE IMPROVEMENT PROJECT(S) AND OTHER REGULATORY PROJECTS, INCLUDING DOCUMENTING PERFORMANCE INDICATORS, OUTCOMES MEASURES, PROCESS MEASURES, PROCEDURES, INTERVENTIONS, AND REPORTING TO CMS/DOH/IPRO.
• DRAWS AD-HOC PROJECTS THAT SERVE TO EDUCATE AND BUILD PROVIDER AWARENESS OF BEHAVIORAL HEALTH ASPECTS OF CARE AND SUPPORT OTHER STATE AND PLAN INITIATIVES REQUIRING PROVIDER EDUCATION.
• ACTIVELY PARTICIPATES IN QUALITY COMMITTEES OR WORKGROUPS SUCH AS THE HEALTH STATUS IMPROVEMENT TEAM (HSIT) WORKGROUP.
• DEVELOPS AND DELIVERS INTRA-DEPARTMENT TRAININGS.
• CONSISTENTLY APPLIES PDSA METHODOLOGY TO ALL QUALITY IMPROVEMENT WORK.

Required Education, Training And Professional Experience

• Master's degree in a clinical field required.
• Must have a minimum of 10 years' experience in the health care field. Experience must include both clinical and Managed Care.
• 5 years' experience managing staff required.
• Superior project management and documentation skills.
• Must be an expert in HEDIS and QARR requirements.
• Experience with and proficiency in data analysis required.
• Working knowledge of relational database and statistical analyses is a plus.
• Must be familiar with and have a working knowledge with Quality Improvement process improvement methodology strategies including but not limited to PDSA and DMAIC.
• Must be proficient in Microsoft Word, PowerPoint, Excel, and Access.

Licenses And Certifications

• Valid New York State license and current registration to practice as a Registered Nurse (RN), Licensed Practical Nurse (LPN), Licensed Master Social Worker (LMSW), Licensed Clinical Social Worker (LCSW), or Licensed Mental Health Counselor (LMHC) as issued by the New York State Education Department (NYSED).
• Six Sigma Yellow or Green Belt preferred.

Professional Competencies

• Ability to lead and manage others.
• Must possess analytical skills to collect, organize, and present data in a clear and concise manner.
• Ability to assess all work and prioritize as necessary to meet reporting timeframes and deadlines.
• Demonstrated problem solving skills.
• Ability to work in a fast-paced environment with changing priorities.
• Superior oral, written and communications skills.
• Ability to understand and communicate analytic and clinical data to varied audiences.
• Ability to work independently and in team setting.
• Must be able to make effective and timely decisions by organizing information in a useful manner and orchestrating multiple activities at once to accomplish the goal.
• Must work effectively with others, fostering open dialogue, accountability, and common mindsets within the team.
• Must have integrity, fostering an honest and trusting relationship with co-workers and management, never compromising the Plan, other employees, or self for personal gain.
• Solid analytical and logical skills paired with strong attention to details.
• Must be a versatile, quick learner, who is open to change and enjoys the challenge of unfamiliar tasks.
• Must seek to continuously improve processes for the benefit of the customer by taking personal responsibility for the resolution of customer services.