Quality Management Data Analyst Lead (Remote)

• Annual incentive bonus plan
• State Retirement (pension plan)
• Company paid life and disability insurance
• 401(k) Plan with employer match
• Medical, dental, and vision insurance with low deductible/low cost health plan
• Generous vacation and sick time accrual
• 12 paid holidays
• Wellness Programs

Primary Purpose of Position: This position performs Quality Management, Quality Assurance (QA) and Quality Improvement (QI) activities to encompass monitoring and quality oversight for maintaining and improving the LME/MCO with regards to overall performance. This includes but is not limited to: reporting, surveys, trend analysis and audits to ensure compliance of operational policies.

Role and Responsibilities:

Tasks may include but not limited to:

• Quality Improvement Projects
• Process Mapping
• Internal Audits and Quality Oversight:
• Lean Six Sigma projects

• Partners Access
• General Audits as identified with Subject Matter Experts
• Utilization Management
• System of Care
• Compliance and Quality Management
• Provider Network
• Policies, Procedures, Plans & Program Descriptions
• Consumer Rights
• Tailored Plan/Medicaid Direct Contracts, Accreditation and External Review for regulatory, contractual, and accreditation compliance
• Care Coordination-MHSU and IDD

Quality Assurance Activities

• Assists LME/MCO departments with development and implementation of outcome performance progression and compliance with external contract directives and accreditation mandates.
• Communicates training initiatives as needed for management and delivery of QM Department /Tailored Plan organizational deliverables.
• Processing, tracking and facilitation of Partners grievances protocols and processes as applicable
• Provides essential performance information to include data and reports to Management Team to include, Chief Performance and Compliance Officer, Quality Management Director, as well as QM Team members and external stakeholders.
• Ensures integrity of data through quality checks and vetting of information in a systematic, industry acceptable standard/methodology
• QA Pop Up Project-PUPs (development, coordination and oversight)
• Assist in development, dissemination and analysis of provider, consumer, staff, and stakeholder surveys for quality assurance and performance improvement purposes.
• Provides technical assistance to departments as follow-up to findings.
• Assist in developing remediation plans or activities based on evaluations of survey or audit results, i.e. NC-TOPPs outcomes.
• Develop internal process evaluations i.e.: Mystery Shopper, to ascertain organizational compliance and quality customer service provision and influence change when applicable through the performance improvement projects. Maintains effective work relationships with LME/MCO staff, Partners BHM departments overall with a focus on Community Stakeholders to assure needs and concerns of the network community are effectively and impartially addressed.
• Assist in annual QM Evaluation data collection, development, delivery
• Verifies compliance of Plans of Corrections, as appropriate.
• Participates and/or Facilitates QM team responsibilities as a group

Quality or Performance Improvement Activities

• Reports findings to organizational leadership as designated.
• Conduct specialized reviews, inquiry, investigations, focused studies and research projects to include analysis or interpretation of such activities.
• Identifies through data analysis the need for performance improvement projects, develops and recommends project plans, monitors progression, trends, gaps, and opportunities for continued improvement.
• Coordinates performance indicator reports; conducts research as applicable.

Other QM Activities

• Assists in organizational quality review processes as appropriate.
• Participates in all duties as delegated and applicable.
• Participates on Quality Committees as delegated.
• Participates with QM internal department goal and outcome initiatives.

Knowledge, Skills and Abilities:

• Ability to understand needs and concerns of QM Team, Tailored Plan Departments, Executive and Management Leadership and Community Stakeholders.
• Computer software knowledge, usage and operational skills required to complete tasks, i.e. Proficiency in EXCEL.
• Highly skilled in problem solving, data and information analysis
• Demonstrated knowledge and skills in the areas of data reporting and dissemination to facilitate performance monitoring and oversight for QM Team and Tailored Plan departments
• Ability to synthesize data and information efficiently and effectively
• Considerable knowledge of the Quality Management and Quality Assurance process and philosophies to include knowledge of TP/Medicaid Direct Plan Departmental activities such as Provider Network, Utilization Management functions.
• Ability to implement and facilitate communication, outcome resolution and quality standardization/evaluation when applicable through the MCO partnerships

Education/Experience Required: Bachelor’s Degree and 2 years of experience in Quality Management or a related area in data collection, reporting and/or analysis or an equivalent combination of education and experience.

Education/Experience Preferred: Concentration in Quality Management or related area and two [2] years of experience in collecting, reporting and analyzing data in a Human Service/healthcare setting.

Licensure/Certification Requirements: Lean Six Sigma- Greenbelt Certification