Affinity Health Plan

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  • Project Manager- Medicare Quality Improvement

     

     

    Affinity Health Plan, an independent, growing, not-for-profit managed care company designed specifically to serve the needs of low-income New Yorkers, needs a Project Manager- Medicare Quality Improvement. In this position, you will effectively manage the development and implementation of the Medicare Quality Improvement Program within the Quality Management Department and throughout Affinity Health Plan, ensuring that all CMS regulations are adhered to and all quality improvement program procedures and work flows meet internal and external deadlines and requirements. 

     

    As part of your responsibilities, you will: 

     

    1. Manage the development, implementation and successful completion of all Medicare and Medicaid quality improvement program projects including, but not limited to HEDIS and QAPI Studies, Member Grievances, Clinical Guidelines/Standards, and all other performance improvement initiatives and CMS-mandated projects 

     

    1. Oversee the tracking, trending and reporting of internal and external Medicare quality management data; prepare and present reports for internal and external committees and customers; prepare and maintain minutes; maintain, review and participate in the revision of departmental and corporate policies, procedures and protocols 

     

    1. Supervise the development of Medicare performance improvement initiatives by the QIC/QMS staff and oversee education/outreach projects with health care providers and appropriate Affinity staff 

     

    1. Monitor and coordinate the design and development of  Medicare data retrieval tools, flow charts and review processes for HEDIS and other quality improvement monitoring activities; collaborate in the development and implementation of protocols for QAPI and other clinical studies 

     

    1. Actively participate in the HEDIS / QARR review process, and work with provider sites on improving performance to achieve desired results 

     

    1. Develop, implement and maintain all policies, procedures, protocols and other documents related to Affinity Dual Eligible and Medicare Programs; updates them according to the predetermined schedule, ensures adherence to Medicare and pertinent Medicaid regulations, and interprets them for all involved Affinity staff to enable appropriate compliance 

     

    1. Provide staff training and development activities to achieve objectives of orientation, knowledge and skill enhancement, proficiency/productivity and professional growth in the area of Medicare regulations, requirements and programs; ensure that staff has the opportunity to utilize skills as needed per project requirements 

     

    1. Interface effectively with Affinity Health Plan providers and staff as a facilitator, resource, educator, problem-solver and collaborator for all Medicare-related quality management projects; represent Affinity to external customers, especially  CMS and NYSDOH regulatory agencies, by overseeing execution of all mandated activities and projects to a timely and successful conclusion 

     

    1. Perform other duties or responsibilities as necessary or assigned 

     

     

    Requirements for this position include: 

     

    • New York State RN or LPN license 
    • BA/BS degree or equivalent experience 
    • Minimum of two years clinical nursing experience in a health care setting 
    • Minimum of one year Medicare and/or Dual Eligible quality management experience in a managed care setting 
    • Administrative experience in a health care environment and project management experience preferred 
    • Knowledge of QM/CQI principles, CMS requirements and regulations, NYSDOH and NCQA/JCAHO standards and regulations 
    • Experience with reporting Medicare HEDIS and conducting clinical studies 
    • Excellent analytical, verbal, written, organizational and interpersonal skills 
    • Intermediate level proficiency with Microsoft Office applications and data management reporting. 

     

     

    If you meet or exceed these qualifications and are interested in this position, please respond by sending an email with your resume to  hrservices@affinityplan.org with the position title in the subject line. You can also fax your resume to 718-794-7846, stating that you are applying for this position on the fax cover sheet. We are an Equal Opportunity/AA Employer. Only qualified applicants will receive a response. 

      

    No agency responses, please.