Work Shifts

9:00 A.M - 5:00 P.M Monday-Friday (35 Hours per week)

Duties & Responsibilities

Purpose of Position:

Under direction, administers activities and programs assigned to a group of Health Care Program Planner/Analysts or related personnel. Plans, initiates, monitors and directs studies and analysis of issues critical to the delivery of health care by the System. Ensures optimal utilization of resources and compliance with the operating standards of various health care governing and accrediting bodies, resulting in improved patient experience and outcomes.

Examples of Typical Tasks:
1. Directs and organizes the development of health care planning projects. Initiates the development of conceptual and analytical prototypes.
2. Identifies issues to be studied, develops and initiates analytical and quantitative models and approaches, and provides for the application of appropriate analytical methods and techniques.
3. Directs and coordinates activities of an organizational unit(s) concerned with one or more aspects of health care program planning. Directs staff, sets unit priorities, evaluates work and provides ongoing guidance to assigned staff.
4. Opens up channels of communication with the System's managerial personnel, community groups and representatives of governmental and health care agencies to maximize planning activities.
5. Provides consultative services to Operations, Medical and Professional Affairs and other groups, as needed, related to methodology for planning and evaluating specific health care programs.
6. Directs evaluation studies and program performance audits.
7. Presents results of studies, analyses, evaluations, etc. and promotes their acceptance and/or adoption. Sets the overall standards for research and investigating criterion for the unit(s).
8. Participates in internal/external quality assurance/performance improvement (QA/PI) activities, programs, training and relevant health care events, as required.
9. Performs related duties, as necessary.

Minimum Qualifications
1. A Master's Degree from an accredited college or university in Public Health, Public, Hospital or Business
Administration, Health Care Specialization, Engineering, Social Services or a related discipline; and four (4)
years of progressively responsible experience relating to health care program planning, research, design,
operations, evaluation and analysis, one (1) year of which must have been in supervision or planning and/or
analysis; or
2. A Baccalaureate Degree from an accredited college or university in disciplines, as listed in #1 above; and five
(5) years of progressively, responsible experience relating to health care program planning, research, design,
operations, evaluation and analysis, one (1) year of which must have been in supervision or planning and/or
analysis; or
3. A satisfactorily equivalent combination of education and experience, in which 30 graduate-level semester
credits from an accredited college or university can be substituted for one year of experience. However, all
applicants must have at least a Bachelor's Degree.

Department Preferences

The Director of Program Quality, Performance Improvement, and Network Management leads the development, implementation, and evaluation of quality assurance, performance improvement (QAPI), and network oversight strategies for the NYC Health + Hospitals (NYC H+H) Medicaid Health Home and other care management programs. This position plays a critical leadership role in strengthening care coordination services, driving outcome-based improvements, and managing network partner performance across contracted Care Management Agencies (CMAs). The Director ensures alignment with state and federal requirements, supports audit readiness, leads cross-functional training initiatives, and serves as a key liaison with Epic EMR and clinical operations teams.

AREAS OF RESPONSIBILITIES:
• Quality and Performance Improvement Leadership
• Program and Network Management
• Policy, Compliance and Regulatory Readiness
• Training and Capacity Building
• Technology and EMR Optimization

Quality and Performance Improvement Leadership :
• Lead the Quality Management Program for the Health Home and other care management programs, including monthly Quality Committee meetings, gap-in-care analyses, and performance improvement initiatives.
• Develop and execute data-driven QAPI strategies to improve care coordination outcomes and compliance.
• Establish performance metrics and dashboards aligned with NYS Health Home standards (e.g., HEDIS, utilization, engagement, and satisfaction).
• Conduct and oversee regular chart reviews and compliance audits using standardized tools.
• Develop and implement corrective action plans, trainings, and coaching for underperforming teams and CMAs.
• Maintain a tracking and filing system for CMA incident reports; ensures that all reports are filed as needed internally and with Lead Health Home and and/or New York State Department of Health. Verifies that recommended follow-up/corrective action is issued and completed by target dates as appropriate to federal, state, local and system policy. Program and Network Management
• Serve as the primary representative to federal, state and local regulatory agencies for program oversight. Maintains primary responsibility for knowledge of federal, state, local, and payer policy/guidelines, regularly providing updates to leadership of program changes and areas of concern and draft suggested action plans for rectifying any perceived gap areas.
• Ensure all Health Home policies are developed/updated timely to reflect updates in program requirements and needs observed while carrying out oversight activities.
• Provide leadership and oversight of the Health Home CMA network, ensuring performance accountability, contract compliance, and alignment with lead Health Home goals.
• Serve as the primary liaison between NYC H+H and network CMAs regarding quality, operations, and technology integration.
• Support CMA onboarding, ongoing monitoring, and performance review; coordinate remediation efforts as necessary.
• Maintain strong collaborative partnerships across the network to drive shared goals and service excellence. Represent the organization in a professional and positive manner at all times.

Policy, Compliance, and Regulatory Readiness:
• Maintain expertise in Medicaid Health Home policy, payer guidelines, and federal/state regulations. Ensure audit readiness and lead preparation for state and external reviews; support follow-up and corrective actions.
• Ensure regulatory standards and compliance. Maintain absolute privacy, confidentiality and security of all information pertaining to employees and patients. Adhere to health system and Community Care policies and procedures, HIPAA/ Privacy Program, Compliance Program, Code of Conduct and Ethics, and Conflict of Interest.
• Collaborate with the Compliance Officer in identifying and addressing regulatory issues that may impact the program including but not limited to the proactive identification of compliance risks, support for the development of Community Care's annual compliance work plan, and responding to operational and billing audits.

Training and Capacity Building:
• Work independently and/or partners with Community Care Workforce Development team to develop and implement curriculum and training materials designed to support high quality service delivery that meet and exceed program, system and regulatory standards for quality benchmarks such as HEDIS measures, triple aim initiatives (reduce hospital and ER/ED visits; increase primary care connections) and any other identified quality metrics.
• Facilitate learning collaboratives, case conferences, and peer sharing forums.
• Support staff development through tailored education, job aids, and process improvement tools. Technology and EMR Optimization
• Serve as program lead for the Epic Care Management platform, including user support, training, and enhancement planning. Participate in Epic governance and project meetings, and ensure Health Home needs are addressed.
• Serve as the primary liaison between contracted CMAs and the EMR team to input and monitor tickets associated with identified issues within the Epic Care Management platform.
• Maintain expertise in working within the EMR; verifies staff compliance with NYC H+H policies & procedures related to the use of the EMR. Provides EMR training support as needed.
• Analyze work processes and provides strategic advice on the development and improvement of the Care Management.

Knowledge in:
• Health Home policies and procedures
• Quality Assurance models and practices
• Development of Trainings

YEARS OF EXPERIENCE:

Minimum of 3-4 years' experience providing progressive oversight and supervision of clinical records/direct staff supervision preferred

Benefits

NYC Health and Hospitals offers a competitive benefits package that includes:

• Comprehensive Health Benefits for employees hired to work 20+ hrs. per week
• Retirement Savings and Pension Plans
• Paid Holidays and Vacation in accordance with employees' Collectively bargained contracts
• Loan Forgiveness Programs for eligible employees
• College tuition discounts and professional development opportunities
• College Savings Program
• Union Benefits for eligible titles
• Multiple employee discounts programs
• Commuter Benefits Programs

If you wish to apply for this position, please apply online by clicking the "Apply for Job" button or forward your resume to [redacted] noting the above Job ID # 134616.