Lead the development, implementation, and management oversight of the company's Coordinated Care Organization (CCO) Quality Incentive Measures (QIM) program. Facilitate multi-disciplinary teams to develop aligned strategies, share best practices, and remain up to date on Oregon Health Authority (OHA) policies, metric specifications, and changes to the CCO QIM program across all regions. Collaborate extensively with internal and external stakeholders (e.g. Population Health, Health Services, Provider Network, Operations, Analytics, Regional and Line of Business leaders) as well as other identified stakeholders, to address all aspects of QIM performance. This position requires fluency with CCO QIMs, including metric specifications, calculations and data sources, as well as the ability to interpret complex data to inform quality improvement strategies.

Essential Responsibilities:

• Lead, develop, and implement CCO QIM multi-year work plans to support continuous quality improvement and achieve strategic goals.
• Collaborate with and work cross functionally to influence, lead, and promote change that drive continuous quality performance improvement.
• Accountable for ensuring responsible parties are improving QIM performance both internally and externally.
• Oversee metric data flow and ongoing monitoring of performance across quality measures.
• Analyze data to understand patterns in performance and variations across populations that can support quality improvement efforts and equity-focused strategies.
• Identify and implement strategic and tactical internal and community initiatives aimed at maximizing member outcomes and QIM results across all PacificSource CCO regions.
• Serve as a core resource and point of contact for internal and external partners, including the OHA, applying in depth understanding of specifications, data sources and other key aspects of the CCO QIM program across all regions. This includes but is not limited to interpretation and dissemination of information regarding changes to the metric program, including impacts to current workflows, strategy and policy; advocacy on behalf of partners to OHA and decision-making bodies around the QIM program and proposed changes to the quality metrics; and, promotion of opportunities for participation in metric-focused technical assistance offered by OHA or other organizations.
• Report out on current metric performance, strategy, potential risks and program developments to internal leadership and governing bodies. This includes management and oversight of the QIM performance dashboards, work plan progress. and forecasting; elevate performance risks and mitigation plans for metrics not meeting improvement targets; and, collecting and summarizing program performance data, identify opportunities for improvement, and presenting findings and recommendations to leadership.
• Participate in statewide and regional workgroups, learning collaboratives, and advisory committee meetings to stay informed on metric program development and best practices.
• Conduct annual program evaluation, identify areas of opportunities, present findings, and recommendations to key stakeholders and leadership.
• Serve as Health Plan subject matter expert on the OHA QIM program and Technical Specifications.

Supporting Responsibilities:

• Meet department and company performance and attendance expectations.
• Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
• Perform other duties as assigned.

SUCCESS PROFILE

Work Experience: Minimum of 5 years of experience in managed care with emphasis on quality improvement programs. Experience with Oregon Medicaid, program development, project management, and quality improvement strongly preferred. Proven track record of managing multiple high-risk, high-visibility, initiatives from definition through implementation

Education, Certificates, Licenses: Bachelor's Degree required in a related field required. Candidates with an associate's degree and 2 years of relevant experience, or a high school diploma and 4 years of relevant experience, in addition to the required minimum years of work experience will also be considered. Graduate degree preferred.

Knowledge: Knowledge of Medicaid programs, CCO structure, incentive metrics programs, national measure specifications and quality improvement strategies strongly preferred. Solid experience in using computers and various software applications including Word, Excel, PowerPoint, Outlook, SharePoint and Tableau. Strong organizational skills and attention to detail. Expertise in project management, thorough understanding of health care operations, process improvement, business analysis and program planning and evaluation. Proven track record in managing multiple high-risk, high-visibility, initiatives from definition through implementation. Ability to motivate others, strong interpersonal and communication skills (oral and written).

Competencies:

Adaptability

Building Customer Loyalty

Building Strategic Work Relationships

Building Trust

Continuous Improvement

Contributing to Team Success

Planning and Organizing

Work Standards

Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 5% of the time.

Skills:
Accountability, Collaboration, Communication (written/verbal), Flexibility, Listening (active), Organizational skills/Planning and Organization, Problem Solving, Teamwork

Compensation Disclaimer

The wage range provided reflects the full range for this position. The maximum amount listed represents the highest possible salary for the role and should not be interpreted as a typical starting wage. Actual compensation will be determined based on factors such as qualifications, experience, education, and internal equity. Please note that the stated range is for informational purposes only and does not constitute a guarantee of any specific salary within that range.

Base Range:
$72,443.87 - $126,776.77

Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.

Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.