Description

Duties

• Identify the areas of clinical care impacted by the statewide State Directed Payment (SDP) strategy, scope, providers included/excluded, and care and services impacted.
• Identification and recommendation of quality performance measures specific to the scope of the SDP and applicable to the care delivered.
• Ensure federal compliance for quality measure selection, including identification of CMS Core Measures, use of MCO contracted measures when appropriate, and assurance that billing codes and services are captured within the measure selected.
• Serve as the agency’s representative in stakeholder meetings for quality aspects of SDP, including representation of agency quality priorities, obtaining stakeholder feedback in the process, addressing concerns, engaging stakeholders in quality improvement, and providing updated data to support quality improvements and evaluation of the strategy. Stakeholders may include MCOs, provider associations, providers, etc.
• Coordinate with stakeholder, MCO, and agency quality partners to support quality initiatives in alignment with agency and legislative direction, as appropriate. Facilitate agency approval of quality initiatives through the agency's quality committee.
• Lead and facilitate SDP Quality Workgroup.
• Coordination with data team to support production of measure specific to SDP provider and enrollee population meeting SDP evaluation submission timeline.
• Annual evaluation of performance, review within SDP Workgroup, QMMI, and Quality Strategy Workgroup with appropriate stakeholder feedback.
• Submission of evaluation to CMS with quality metrics explanation for strategy, link to Quality Strategy, and change from statewide approach to CMS-compliant approach.
• Alignment of MCO and EQRO contracts for use and reporting of SDP measures.
• Messaging to MCOs for SDP measures, inclusion in QAPI evaluations and provider relations work.
• Reporting out of evaluation of the Quality Strategy through EQRO's Technical Report, including EQRO contract and deliverables oversight.
• Serve as back up for clinical oversight of EQRO, including tracking of deliverables, budget, and agency-required responses to meet federal regulations. Represent agency needs and interests in work with EQRO. Communicate EQRO status and work to supervisor to support agency initiatives.
• Use clinical judgment and expertise to review proposed legislation with potential clinical implications. Provide written narrative analysis as part of review of legislation; coordinate with section staff.

Qualifications

• Ability to analyze and resolve complex problems.
• Ability to independently manage competing timelines to meet critical deadlines and handle multiple projects at a time.
• Ability to write clear, narrative, analytical reports.

• Two (2) years’ experience in quality assurance and improvement principles and approaches.
• Experience in Medicaid managed care operations.
• Knowledge in National Committee for Quality Assurance (NCQA) Compliance Audit process and accreditation standards for Medicaid Health Plans.
• Knowledge in Healthcare Effectiveness Data and Information Set (HEDIS®) measures and audit process.
• Knowledge in Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Survey measures and process.
• Experience in contract management and accountability, procurement, contracting using outcomes-focused performance measures.

• State and federal laws, policies, regulations and procedures on Medicaid and healthcare. Contract terms and processes.
• Managed care operations, delivery systems, and customer service.
• Program development, implementation, and evaluation.
• Care needs of low income, vulnerable Medicaid recipients in Washington State

Only candidates who reflect the minimum qualifications on their NEOGOV profile will be considered. Failure to follow the application instructions below may lead to disqualification. To apply for this position, you will need to complete your profile which includes three professional references and attach:

• A cover letter that specifically addresses how you meet the qualifications for this position.
• Current resume

• Attach a copy of your DD214 (Member 4 long-form copy), NGB 22, or USDVA signed verification of service letter.
• Please black out any PII (personally identifiable information) data such as social security numbers. Include your name as it appears on your application in careers.wa.gov.

Supplemental Information

• Meaningful work with friendly co-workers who care about those we serve Voices of HCA
• A clear agency mission that drives our work and is person-centered HCA's Mission, Vision & Values
• A healthy work/life balance, including alternative/flexible schedules and mobile work options.
• A great total compensation and benefit package WA State Government Benefits
• A safe, pleasant workplace in a convenient location with restaurants, and shopping nearby.
• Tuition reimbursement
• And free parking!