CareOregon Looking for Value-Based Payment and Medicare Analytics Manager at Portland, OR  Full Time

To protect the health and well-being of our members, employees and community, CareOregon requires all employees to be fully vaccinated against COVID-19 or have an approved medical or religious exception as a qualification of employment.

Candidates who receive an offer of employment by CareOregon, must provide proof of COVID-19 vaccination or submit a medical or religious exception request, which will be evaluated in accordance with CareOregon’s standard accommodation process.

Position Title: Value-Based Payment and Medicare Analytics Manager

Department: Network and Clinical Support

Title of Manager: Title of Manager: Director, Network Analytics and Evaluation

Supervises: Supervises: Quality Improvement Analysts

Exemption Status: Exempt

Requisition ID: 22808

Job Summary

This position manages the operations, projects and planning for analytics teams focused on Medicare Stars, HEDIS, value-based payment, and other data-sharing and/or quality improvement programs. These teams are responsible for analyzing, monitoring, reporting, and providing technical collaboration on clinical quality improvement activities related to these programs. This position monitors staffing and resource needs, develops staff members, recommends policies, and leads process improvement efforts. Additionally, this position works with department leadership on plan-wide quality improvement and data strategy activities. The position assists in developing a long-term plan for analytics and evaluation activities to support the needs of the organization, including enterprise data and analytics solutions.

Essential Responsibilities

Technical Leadership

• Lead analytics activities for the organization related to Medicare Stars, HEDIS, and value-based payment.
• Oversee the ongoing analysis of data relevant to the functional areas of the unit.
• Identify opportunities and develop plans for improvement.
• Provide leadership in quality, cost, value-based payment programs, evaluation, and regulatory reporting.
• Establish department processes and monitor workflow and resource needs.
• Study and analyze tables, graphs, charts and report results in a variety of formats.
• Plan, organize, manage and monitor work projects.
• Ensure unit work is integrated and performing in coordination with other relevant CareOregon departments.

• Keep abreast of best practices in clinical quality measurement and incorporate these practices into the team’s work.

• Participate in CareOregon, OHA, or national workgroup meetings and committees related to clinical quality improvement and data analysis as needed.
• Represent CareOregon at internal and external partner meetings.

Planning

• Develop and implement policies and procedures that are compliant with OHA and CMS regulations as well as NCQA.

• Lead the planning, design, and implementation of new analytic strategies and methodologies.
• Assist the Director with short-term and long-term analytics planning.
• Provide recommendations to senior management on strategies for meeting performance goals.
• Assist management with team budget development and monitoring.

Supervision

• Identifies work and staffing needs to meet work expectations; recruits and hires, using an equity, diversity, and inclusion lens.
• Plans, organizes, schedules, and monitors work; ensures employees have information and resources to meet job expectations.
• Leads the development, communication, and oversight of team and individual goals; ensures goals, expectations, and standards are clearly understood by staff.
• Trains, supervises, motivates, and coaches employees; provides support toward employee development.
• Incorporates guidance from CareOregon equity tools into people leadership, planning, operations, evaluation, and decision making.
• Ensures team adheres to department and organizational standards, policies, and procedures.
• Evaluates employee performance and provides regular feedback to support success; recognizes strong performance and addresses performance gaps and accountability (corrective action).
• Performs supervisory tasks in collaboration with Human Resources as needed.

Organizational Responsibilities

• Perform work in alignment with the organization’s mission, vision, and values.
• Support the organization’s commitment to equity, diversity, and inclusion by fostering a culture of open mindedness, cultural awareness, compassion, and respect for all individuals.
• Strive to meet annual business goals in support the organization’s strategic goals.
• Adhere to the organization’s policies, procedures, and other relevant compliance needs.
• Perform other duties as needed.

Knowledge, Skills, and Abilities Required

• Experience working with complex data sets
• Strong understanding of health care quality reporting programs, specifically Medicare Stars and HEDIS
• Strong understanding of best practices in data visualization
• Strong understanding of value-based payment concepts and related measurement strategies
• Knowledge of SQL coding
• Knowledge of managed care concepts and principles and basic health plan operations
• Knowledge of health plan regulatory reporting requirements of Medicaid and Medicare managed care, specifically Medicare STARS measures
• Ability to operationalize quality improvement and process improvement concepts, principles, and practices
• Excellent analytical, problem solving and decision-making skills
• Proficient user of Microsoft Office programs, Tableau, or other statistical software
• Ability to provide leadership to groups of people and as the implementation of projects
• Ability to manage multiple tasks and projects and to delegate as deemed appropriate
• Excellent reading, oral and written communication and interpersonal skills
• Ability to effectively collaborate with leadership.
• Ability to work independently
• Ability to work in an environment with diverse individuals and groups
• Ability to mentor individual growth
• Ability to support and comply with organizational policies, procedures and guidelines
• High degree of initiative and motivation

Physical Skills and Abilities Required

Lifting/Carrying up to 10 Pounds Pushing/Pulling up to 0 Pounds Pinching/Retrieving Small Objects Crouching/Crawling Reaching Climbing Stairs Repetitive Finger/Wrist/Elbow/ Shoulder/Neck Movement

0 hours/day 0 hours/day 0 hours/day 0 hours/day 0 hours/day 0 hours/day More than 6 hours/day

Standing Walking Sitting Bending Seeing Reading Hearing Speaking Clearly

0 hours/day 0 hours/day More than 6 hours/day 0 hours/day More than 6 hours/day More than 6 hours/day More than 6 hours/day More than 6 hours/day

Cognitive and Other Skills and Abilities

Ability to focus on and comprehend information, learn new skills and abilities, assess a situation and seek or determine appropriate resolution, accept managerial direction and feedback, and tolerate and manage stress.

Education and/or Experience

Required:

• Minimum 5 years’ progressive experience in a quality improvement, analytics, research, or related work
• Minimum 2 years’ experience in a supervisory position
• Bachelor’s degree in Business, Analytics, Healthcare, or related field

Preferred:

• Experience working with the Oregon Health Plan (OHP) benefit, the Oregon Health Authority (OHA) and/or the Centers for Medicare and Medicaid Services (CMS) rules and regulations

• Environment: This position’s primary responsibilities typically take place in the following environment(s) (check all that apply on a regular basis):

Inside/office Clinics/health facilities Member homes

Other_________________________________________

• Travel: This position may include occasional required or optional travel outside of the workplace, in which the employee’s personal vehicle, local transit, or other means of transportation may be used.
• Equipment: General office equipment
• Hazards: n/a

Candidates of color are strongly encouraged to apply. CareOregon is committed to building a linguistically and culturally diverse and inclusive work environment

Veterans are strongly encouraged to apply.

Equal opportunity employer. This company considers all candidates regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status.