Quality Performance Outcomes Manager

The Quality Performance Outcomes Manager is responsible for managing and facilitating the quality improvement outcomes for our centers. These outcomes can include, but are not limited to: NCQA HEDIS®, Pharmacy Quality Alliance (PQA), CMS Stars, CMS Core Set, Risk Adjustment, and State-specific metrics.

This role utilizes metrics to track trends and monitor performance, generate actionable insight, and develop plans to meet goals according to each contracted Payer. The Outcomes Manager works collaboratively with center and cross-functional leadership to create a culture of continuous quality improvement supporting the execution of the Quality Strategy.

Duties And Responsibilities

• Serve as a liaison to centers to provide continuous monitoring for performance outcomes, providing expert functional and technical knowledge of HEDIS and other performance metrics.
• Develop, recommend, and implement interventions at the center and membership level to improve quality outcomes.
• Create and execute intervention work plans to drive quality improvement.
• Conduct root-cause analysis and develop interventions in response to findings.
• Collaborate with centers to facilitate quality improvement in the clinical care model.
• Review and interpret data and performance reports such as external and internal care gaps, pay for performance, risk adjustment.
• Conduct research in the electronic health record system based on identified member opportunities.
• Regularly present findings to center leadership, collaboratively discussing performance at the member, provider, and payer-level.

Minimum Qualifications

• Bachelor’s degree in healthcare, business, public health preferred but not required.
• 2 years’ experience in analysis or provider/medical operations experience preferred.
• 2 years’ experience supporting organizational change, performance/process improvement preferred.
• 1+ years’ experience with quality improvement, HEDIS, or Star Ratings.
• Intermediate experience with Microsoft Excel.

Working conditions

This job operates in a professional office environment. This role routinely uses general office equipment.

Physical Requirements

• Ability to communicate clearly and exchange accurate information constantly.
• Ability to remain stationary for long periods of time.
• Constantly operates computer, keyboard, copy and fax machine, phone, and other general office equipment.

Direct reports

None.