Quality Project Manager
hace 21 días
West Palm Beach
Job Description About Us: We are one of the top accountable care organizations (ACO) in the United States. Our company produces and manages proprietary applications, including multiple physician-facing mobile and web apps designed to enhance care coordination for our ACO participants. We are dedicated to driving innovation and excellence in value-based care. Position Summary: The ACO Quality Project Manager provides strategic leadership and operational oversight for enterprise-wide quality programs, such as the Medicare Shared Savings Program (MSSP), ACO REACH, and Commercial payer programs. This role is accountable for end-to-end quality program performance, including planning, execution, reporting, audit readiness, and continuous improvement. The Project Manager partners closely with executive leadership, provider consultants, analytics, IT, and practice leadership to translate regulatory and payer requirements into actionable strategies that improve patient outcomes, optimize contractual performance, and mitigate compliance risk. This position owns quality initiatives from design through results, drives cross-functional alignment, manages complex timelines and dependencies, and ensures measurable, sustainable improvement across the ACO. Key Responsibilities: Quality Strategy, Program Leadership & Planning • Own the quality strategy for assigned ACO payer programs, aligning annual quality goals with organizational priorities and contractual benchmarks., • Develop and maintain an annual Quality Improvement Strategic Plan, including targeted interventions, timelines, owners, and success metrics., • Lead targeted quality improvement efforts for high-impact measures (e.g., diabetes, hypertension, cancer screening), ensuring alignment across clinical, operational, and analytics teams., • Proactively assess program risk, performance gaps, and readiness, escalating issues and recommending corrective action plans to leadership. Quality Program Execution, Oversight & Reporting • Provide oversight and accountability for all quality reporting activities, ensuring accurate, complete, and timely submissions across payer programs., • Direct the development, enhancement, and distribution of Gaps in Care reports for assigned ACO payer programs ensuring reports are actionable and aligned with payer rules., • Prepare and manage clinical quality measure readiness efforts in collaboration with internal analysts and technical teams, ensuring EHR alignment and measure mapping accuracy., • Manage quality attestations end-to-end ensuring secure intake (fax, SuperDoc App, encrypted email, Sidekick), timely follow-up, tracking, and submission., • Provide executive-level quality performance updates to leadership, including trends, risks, mitigation strategies, and projected outcomes. Data Collection, Validation & Analysis • Oversee data validation processes, claims research, and targeted medical record audits to substantiate numerator compliance and exclusions., • Analyze performance trends and root causes of underperformance, translating insights into prioritized action plans for practices and consultants., • Ensure compliance with payer-specific requirements, including MSSP CQMs, ACO REACH HEDR adjustments, HEDIS measures, and Health Equity Plan deliverables. Practice Support & Provider Engagement • Lead practice-facing quality initiatives in partnership with Provider Consultants, driving adoption of standardized workflows and best practices., • Guide practices through complex quality requirements, helping them operationalize care gap closure, documentation standards, and patient outreach strategies., • Ensure practices receive timely, clear, and consistent performance feedback and targeted improvement recommendations., • Serve as an escalation point for quality-related barriers impacting provider performance or patient outcomes. Training, Education & Subject Matter Expertise • Design and deliver scalable training programs for providers, practice staff, consultants, and internal teams on quality programs, documentation standards, and payer requirements., • Serve as the organizational subject matter expert for assigned ACO payer programs, and related frameworks (MIPS, HEDIS, CQMs, STARS, NCQA)., • Ensure providers and staff are trained on effective EHR and template utilization to support accurate data capture and audit readiness., • Promote a culture of continuous quality improvement and evidence-based care across the ACO. Governance, Compliance & Audit Readiness • Ensure ongoing compliance with CMS regulations, payer contracts, NCQA standards, and ACO governance requirements., • Represent quality operations in Quality and Performance Committee meetings, preparing materials, documenting initiatives, and tracking outcomes., • Lead audit readiness activities, including Commercial template audits, Annual Physical audits, and payer-specific reviews., • Oversee successful completion of payer audits with minimal disruption and no material findings. Key Performance Indicators (KPIs): Quality Performance & Strategic Outcomes • 100% of assigned ACO quality payer submissions completed accurately and on time., • ≥85% of ACO primary care practices achieve or exceed assigned quality performance targets., • Demonstrated year-over-year improvement in overall payer quality scores and shared savings contribution., • Successful execution of annual Quality Improvement Strategic Plan with ≥80% of initiatives meeting defined goals. Gaps in Care Closure & Patient Outcomes • ≥70% of identified gaps in care closed prior to reporting deadlines., • Year-over-year improvement in priority clinical outcomes (e.g., A1c control, blood pressure control, cancer screening rates). Compliance, Data Integrity & Audit Readiness • ≥98% accuracy rate across validated quality data sets., • 100% successful completion of payer and regulatory audits with no major deficiencies or corrective action plans., • Completion of routine Annual Physical and template audits with documented follow-up and remediation. Provider, Practice & Stakeholder Engagement • 100% of practices receive structured performance feedback at least annually, with targeted improvement plans as needed., • ≥95% participation rate in required quality trainings for providers, staff, and consultants., • Positive qualitative feedback from practices and consultants regarding clarity, usefulness, and timeliness of quality support. Operational Effectiveness & Continuous Improvement • ≥85% of quality-related projects delivered on time and within scope., • ≥75% of recommended operational or workflow improvements implemented with measurable quality or efficiency gains., • ≥95% of escalated quality issues resolved within defined service-level expectations., • 100% participation and preparedness for Quality and Performance Committee meetings, including timely documentation and follow-up. Qualifications: Education & Experience: • Bachelor’s degree in nursing, Public Health, Healthcare Administration, or related field required; Master’s degree preferred., • Minimum 3–5 years of experience in healthcare quality or performance improvement, preferably in an ACO or value-based care setting., • Experience with quality measurement programs such as CMS ACO measures, HEDIS, STARS, and CAHPS required., • Experience conducting data analysis and using QI methodologies (Lean, Six Sigma, PDSA, etc.). Licensure/Certifications: • Certified Professional in Healthcare Quality (CPHQ) or equivalent preferred., • Clinical licensure (e.g., RN, LPN) a plus but not required. Knowledge, Skills, and Abilities: • Knowledge of quality improvement theory, strategy, and practical methods to achieve rapid cycle improvement., • Familiarity with regulatory requirements and accreditation standards in healthcare (e.g. HEDIS)., • Experience with electronic health record (EHR) systems and healthcare data analytics tools is a plus., • Ability to establish and maintain positive professional working relationships within and outside organization., • Outstanding interpersonal, service excellence behavior and customer service skills required., • Effective oral and written communication and presentation skills., • Must be a team player and contribute to building a strong team dynamic., • Ability to perform effectively under pressure, maintain focus on responsibilities, and manage competing priorities., • Ability to evaluate data, establish facts, and draw valid conclusions., • Ability to draft reports (committee memos, clinical investigations)., • Must be self-motivated, organized, and detail oriented., • Adheres to HIPAA requirements and maintains confidentiality of all data., • Highly proficient in using Excel, Word, and Power Point In a business setting.
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