Job Description
Department(s): Quality Analytics
Reports to: Director III
FLSA status: Exempt
Salary Grade: N - $95,000 - $155,078
About CalOptima Health
CalOptima Health is the single largest health plan in Orange County, serving one in four residents. Our motto - "Better. Together." - is at the heart of our mission to serve members with excellence, dignity and respect. We are a public agency made up of compassionate leaders and professionals working together to strengthen our community's health. We are continuing to build a culture that promotes diversity and inclusion within our community where employees have a sense of belonging, and are valued for their ideas, contributions, and their unique individual perspectives they bring. CalOptima Health has been recognized as one of Orange County's best places to work, so we know there is something special about our organization. It is why people choose to work here and why they choose to stay!
About the Position
The Manager Quality Analytics (Member Experience) will be responsible for monitoring health plan and health network performance on established quality metrics, member experience and network adequacy standards. The incumbent will communicate the plan and health network performance to stakeholders, including health networks, provider and member stakeholder groups and quality leadership, including the Quality Improvement Committee (QIC) and Board of Directors Quality Assurance Committee. The incumbent will lead a cross-departmental team of professional staff that includes the development of performance measurement reports, review of data to identify and report issues and trends and escalate underperforming entities to stakeholders. The incumbent will oversee the development and implementation of all company surveys to measure member and provider satisfaction. The incumbent will lead the enterprise-wide Member Experience team as well as oversee the development and management of quality improvement plans and corrective action plans issued to underperforming entities. The incumbent will be responsible for the development and submission of documents and reports to CalOptima Health's QIC as part of the overall Quality Improvement Program and meet regulatory requirements and National Committee for Quality Assurance (NCQA) accreditation.
Duties & Responsibilities:

• Cultivates and promotes a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.
• Directs and assists the team in carrying out department responsibilities and collaborates with the leadership team and staff to support short- and long-term goals/priorities for the department.
• Hires, manages, trains, reviews and sets goals for the team.
• Leads efforts to systematically collect, review, assess, analyze and report to leadership and stakeholders the plan and health network level performance on established clinical quality, access and member experience metrics.
• Leads enterprise-wide Member Experience team and drives member experience improvement initiatives. Develops member experience goals for the annual Quality Improvement Workplan and provides oversight of the goals through leadership of the Member Experience team.
• Collaborates with director to report plan and health network access and availability standards performance and establishes goals and initiatives for the annual quality improvement work plan.
• Develops and communicates needs for quality improvement and corrective action plans to health networks, as needed.
• Escalates and reports to Audit and Oversight Committee any health networks failure to comply with required improvement plans or significantly improve performance.
• Oversees vendor management and data collection and reporting activities of member satisfaction surveys, including Consumer Assessment of Healthcare Providers and Systems (CAHPS).
• Leads and actively participates in QIC and subcommittees regarding quality improvement and member experience.
• Ensures successful completion of the annual data and barrier analysis and preparation of related quality reports required to meet regulatory and NCQA accreditation standards.
• Provides leadership and participates in audits conducted by regulatory and accreditation agencies regarding plan and health network level quality performance, tracking and trending.
• Develops, reviews and revises policies and procedures for member experience or other policies as assigned, consistent with, but not limited to, regulatory requirements and NCQA guidelines on an annual basis.
• Ensures timely and accurate submission of reports to regulatory agencies.
• Supports the director in developing an annual budget for the department and manages department budget dollars related to required surveys and member experience improvement initiatives costs.
• Completes other projects and duties as assigned.

Experience & Education:

• Bachelor's degree in Healthcare, Healthcare Informatics or related field required.
• 5 years of experience in a managed health care organization working with NCQA, Centers for Medicare & Medicaid Services (CMS), Department of Health Care Services (DHCS), Department of Managed Health Care (DMHC) and other quality performance standards, metrics and regulatory requirements required.
• 2 years of supervisory experience required.
• An equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above is also qualifying.

Preferred Qualifications:

• Master's degree in Public Health, Healthcare or related field.

Physical Demands and Work Environment:
The physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Physical demands: While performing duties of job, employee may be required to move about the organization. Employee must be able to sit for extended periods of time, as well as work at the computer for long periods. Employee is required to use hands and fingers, especially for typing on the computer and using the mouse. Must also be able to reach with hands and arms and must occasionally lift office supply boxes or laptop case, up to 25 pounds. Employee must be able to communicate, particularly for regular phone use, in meetings, face-to-face interaction and while presenting.

• Work Environment: Typical office environment with minimal to moderate noise levels and controlled office temperatures.

About our Benefits & Wellness options:
At CalOptima Health, we know that a healthy and happy workforce is a thriving workforce, which is why we offer a comprehensive benefits package, including participation in the California Public Employees Retirement System (CalPERS), low-cost medical/vision/dental insurance options, and paid time off. To support quality work-life balance, we allow flexible scheduling during core business hours, telework options for some positions, work schedules that allow every other Monday or Friday off (9/80 schedule), and a wellness program featuring diverse activities. Additionally, CalOptima Health contributes 4% of pensionable earnings to a 401(a) retirement program with no required employee contribution. Employees also have access to 457(b) retirement plans with pre/post-tax contribution options.
CalOptima is an equal employment opportunity employer and makes all employment decisions on the basis of merit. CalOptima wants to have qualified employees in every job position. CalOptima prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics.
If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability.
Job Location: Orange, California
Position Type:
To apply, visit https://jobs.silkroad.com/CalOptima/Careers/jobs/4327
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