| Job Description: |
!*!About WellCare: WellCare Health Plans, Inc. provides managed care services targeted to government-sponsored health care programs, focusing on Medicaid and Medicare. Headquartered in Tampa, Florida, WellCare offers a variety of health plans for families, children, and the aged, blind, and disabled, as well as prescription drug plans. For more information about WellCare, please visit the Company's website at www.wellcare.com.
Our History: Founded in 1985 with three associates, WellCare grew to more than 800 associates and 467,000 members in Florida, New York and Connecticut by 2002. In 2004, the company acquired Harmony to enter the Midwest and became publicly traded. By 2006, WellCare served 2.2 million members as it became a national prescription drug plan provider and the largest Medicaid plan in Georgia. WellCare expanded its services when it began offering Medicaid managed care plans in Ohio and Missouri in 2007, and Medicare managed care plans in Texas and New Jersey in 2008. Additional growth followed when the company was chosen to serve Hawaii's Medicaid program for the aged, blind or disabled in 2009, and in 2011 when it was selected to serve Kentucky's Medicaid program. Today, WellCare has more than 3,900 associates and approximately 2.4 million members nationwide.
EOE: All qualified applicants shall receive consideration for employment without regard to race, color, religion, sex, age forty (40) and over, disability, veteran status, or national origin.The Senior Manager, Quality Improvement Analytics has direct responsibility for all aspects of Quality Improvement and Regulatory Reporting and identifying areas for improved performance. In addition, the incumbent
- Serves as the Subject Matter Expert for all aspects of quality data management, coding and data repositories within the WellCare Corporate Quality Improvement Department to ensure consistent, efficient and streamlined processes are in place to manage reporting on all aspects of quality data requests.
- Leads the Medical Informatics team to ensure compliance to coding principles, data management, data repositories and source code management.
- Leads associates responsible for external audits and the WellCare internal audit and ensures compliance with all aspects of such.
- Has direct responsibility for the Medicare STARS measures reporting, strategy and analysis against competitors, including ensuring areas of opportunity are identified.
- Is responsible for directing activity which includes fact based business analytical and financial support.
- Leads Quality Initiatives across all functions, national markets and states.
- Works closely with every function and key leadership at WellCare, at both corporate headquarters and in the markets.
- Provides satisfaction opportunities for the individual to be part of a winning right team, foundational principles and create a discipline for our growing company.
- Builds and leads a matrix team to design and reengineer core quality functions, platforms, and systems necessary for the successful and ongoing growth and profitability of WellCare.
- Works closely with WellCare's Health Services leadership team, this individual will become familiar with the established vision, mission and overall strategy along with our business objectives of the organization to effectively define, articulate, and address our quality value streams and apply process improvement approaches to deliver significant improvements through a formalized disciplined approach.
Responsibilities:
- Independently manages all aspects of the Quality Improvement reporting process, including the vendor relationships, audit requirements, roadmap completion and direct reporting of measures to the state government partners and the Centers for Medicaid and Medicare Services.
- Directs the completion of all Regulatory, adhoc and internal reporting for all aspects of Quality Improvement, including Part C reporting, CAHPS, HOS, EPSDT and performance improvement projects.
- Ensures compliance related to all HEDIS, Part C Medicare and Regulatory Reporting requirements.
- Ensures compliance with internal audit requirements and follow-up of all departmental procedures.
- Facilitates, manages, and drives enterprise-wide programs and projects through a structured, data-driven, fact based, disciplined process. Responsible for Medicare STARS reporting and analysis of WellCare's progress against competitors, including identifying areas of improvement and supporting the interventions and analysis.
- Develops Financial Models to assess Quality based activities that result in strong ROI's by evaluating but not limited to Claims and utilization data.
- Presents results to management, including data-driven business recommendations and alternatives.
- Evaluates financial impact of implemented initiatives
- Provides leadership and direction to ensure the organization's performance improvement plans for Health Services are translated into measurable tactical goals and objectives to guarantee performance and objectives are met or exceeded.
- Ensures overall program management integrity through internal communication of program requirements and changes and monitoring daily performance.
- Coordinates and trains all Subject Matter Experts for the management of programs and projects.
- Tracks and analyzes company performance and advocate changes where necessary to meet corporate goals.
- Creates monitoring tools to assist in the identification of issues and areas for operational improvement.
- Institutes a tracking system for all programs and build necessary response plans.
- Leads various matrix groups across the company to identify and solve a wide variety of cross-functional issues related to the improved performance and develop fail safe processes to avoid reoccurrences.
- Builds and promotes organizational change Management Initiatives
- Manages the individual pipeline of programs and projects based on attractive ROI's and companywide risk profiles.
- Is part of team that drives strategy for lasting change, ongoing cultural assessment, and organizational competency
- Builds, promotes, and drives organizational change management initiatives; act as a strategic cross-functional change agent.
- Analyzes and translates external reports into actionable items for organizational change.
- Performs special projects as assigned.
Education: A Master's Degree in Public Health, Health Care Administration, Computer Science, Finance, Business Administration, Engineering, Statistics or related field. Experience:
- 5 years experience in health care analytics, including quality improvement and performance measurement design.
- 5 years of direct financial analytics experience.
- 1 years experience in supervising/management associates.
- A broad knowledge and understanding of key intersection of all functional areas such as marketing, sales, operations, finance.
- Proven successful track record, to include: the ability to simplify strategy into simple actions, quickly grasp new ideas and decisions effectively and create focus.
- Managed care experience. Government programs experience within Healthcare industry preferred.
Special Skills (e.g. 2nd language):
- Strong SAS and SQL skills and database knowledge necessary to conduct complicated analysis and reporting.
- Considerable analytic skill necessary to provide efficient and effective solutions to enhance performance and productivity
- Displays considerable judgment in the analysis of problems and significantly affect the financial performance
- Excellent verbal and written communication skills
- Strong project management skills
- Strong analytical and problem solving skills
- Ability to communicate effectively with people with varying levels of education
- Ability to multitask in a fast paced environment
Technical Skills/Requirements:
- Advanced in Microsoft Office Excel, Word, Visio, PowerPoint, Access, and Outlook; advanced proficiency in SAS, SQL, UNIX, ORCL.
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