Program Manager III - Quality at Tufts Health Plan in Watertown, Massachusetts

Job Description:

We enjoy the important work we do every day on behalf of our members.

Job Summary

Under the supervision of the Director Quality, Accreditation and Regulatory Programs, the Quality Program Manager III is responsible for the oversight, design, management and successful completion of QI programs that meet CMS, State contract, State Medicaid agency, and accreditation requirements. He/she consults and/or collaborates with business areas across the organization and formulates and implements actions to insure continued compliance against requirements. He/she facilitates cross-functional meetings and workgroups and interacts as needed with internal business partners. He/she resolves QI program issues by evaluating options, making recommendations, and implementing solutions that meet both program and corporate Tufts Health Plan requirements and objectives. The Quality Program Manager III works to identify and implement opportunities for administrative efficiencies related to quality programs across all products as needed.

Job Description

KEY RESPONSIBILITIES/ESSENTIAL FUNCTIONS

Quality Improvement Program Management

• Manages the design/development, implementation, evaluation and report writing of quality improvement programs and projects according to CMS, State contract, State Medicaid agency and accreditation requirements as assigned. Works cooperatively and collaboratively with individuals and teams within Quality Management (QM) and in business areas throughout the organization that play key roles and support the programs.




• Chairs, records and/or participates in relevant Tufts Health Plan committees and workgroups as appropriate.




• Provides subject matter expertise to business partners on QI program requirements and provides recommendations on how to apply them to the business.




• Manages programs, projects and processes to insure that requirements as indicated by contract and regulatory requirements are met.




• Works with business owners/stakeholders to develop strategy and implement plans to mitigate risks and gaps considering compliance and regulatory requirements and business need and implement changes in requirements.




• Develops and/or contributes to, and manages QI program documentation including but not limited to Corporate Quality Workplan, Corporate QI Program Plan, program-specific workplans, auditing and tracking tools, analysis and reporting plans, policies, and reports. Collaborates with individuals and groups to modify existing documents in response to changes in program requirements as needed.




• Responsible for preparation for all internal and external assessments, audits, site visits, meetings (on or off-site) related to QI programs as assigned. External organizations may include but are not limited to CMS, State Medicaid agencies, External Quality Review Organizations, and NCQA.




• Oversees and coordinates work needing to be completed with the QI Program Manager II within QM and with less senior staff in other departments who provide support to these programs.




• Other duties as assigned to support QI programs related to geographic expansion and other business needs.

Quality Improvement Program Reporting, Research and Data Collection

• Performs data collection and analysis of documentation from various sources (internal and external) to meet compliance and regulatory requirements




• Collaborates with business partners to conduct secondary research and to design and implement qualitative and quantitative analysis as needed. Formulates findings, draws conclusions, makes recommendations for action and works with the business to document the findings and reports based on the data.




• Prepares all written deliverables and presentations with a minimum of direction.

QI Deliverables Preparation

• Responsible for the timely completion of all activities and final deliverables that meet requirements for the QI programs.

Coordinates the work of the Quality Program Manager II.

Responsible to coordinate THPP ACO Quality Improvement meetings and its associated deliverables.

Requirements

EDUCATION: (Minimum education required)

• Bachelor's Degree required. Advanced degree, such as MPH or MHA preferred.

EXPERIENCE: (Years of experience)

• 5-8 years of program management experience, to include leadership of cross-functional projects with significant business impact. Leadership of projects with a compliance/regulatory/accreditation focus is required, preferably in a managed care or related health care environment.


• Experience with State and/or Federal compliance/regulatory/accreditation requirements, in a state or Federal health plan setting.


• Experience with QI program evaluation, data collection and analysis and CQI principles required


• 8-10 years business or industry experience.


• Experience with Government QI programs or similar clinical or quality program management preferred.

SKILL REQUIREMENTS: (Include interpersonal skills)

• Well-developed verbal and written skills.


• Well-developed presentation skills.


• Ability to facilitate planning and review sessions with senior management.


• Excellent organizational skills and ability to successfully manage multiple priorities and tasks.


• Requires attention to detail and the ability to accomplish smaller critical tasks of projects while maintaining a thorough understanding of the project's larger impact on other departments, as well as implications for the company and provider network.


• Primary (qualitative and quantitative) data collection and analysis, secondary research experience.


• Advanced training in the field related to the program is preferred.


• Demonstrates self-direction, possesses a high level of motivation and political astuteness, outstanding interpersonal, teaching, decision making, negotiation, and creative problem solving skills.


• Able to resolve most roadblocks to program progress using knowledge of the company


• Able to instruct others in Program Management techniques and operate in a matrixed environment


• Must be able to work both independently and as part of a team


• Must be able to work cooperatively as a team leader and member


• May be required to coach/mentor less experienced program managers and effectively lead in a matrixed environment


• Must have the ability to lead and motivate fellow employees by fostering team spirit, an attitude of cooperation, and a commitment to the projects

WORKING CONDITIONS AND ADDITIONAL REQUIREMENTS: (include special requirements, e.g., lifting, travel, overtime)

• Fast paced office environment handing multiple demands.


• Must be able to exercise appropriate judgment as necessary.


• Use of telephone and PC required.


• May require occasional evening or weekend hours as projects dictate.


• May require occasional vendor visits overnight.


• Must be able to travel between THP locations on an as needed basis.

CONFIDENTIAL DATA: All information (written, verbal, electronic, etc.) that an employee encounters while working at Tufts Health Plan is considered confidential. Exposed to and required to deal with highly confidential and sensitive material and must adhere to corporate compliance policy, department guidelines/policies and all applicable laws and regulations at all times.

What we build together changes our customer's health for the better. We are looking for talented and innovative people to join our team. Come join us!

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