Director of Provider Data Integrity and Program Management

MetroPlusHealth provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlusHealth's network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlusHealth has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.

Position Overview

Reporting to the Vice President of Provider Network Operations, the Director of Provider Data Integrity and Program Management is responsible for ensuring the highest standards are met for accuracy, accessibility, and availability of the network, including oversite of various vendors. This position will collaborate with other functions on the development of Provider Key Performance Indicators (KPIs) to inform on performance and operational excellence of the network for both internal and external stakeholders. This position is also responsible for various
Network operational reporting and applications to support the daily workflow of Credentialing, Provider Relations and Provider Engagement activities.

• Develop and oversee all the functions of the Data Integrity and Program Management team.
• Oversight of the vendors responsible for the quarterly accuracy & availability surveys, the annual Provider Satisfaction survey as well as data accuracy and adequacy.
• Identify improvements to access and availability of the network and collaborate with various department to execute action plans.
• In collaboration with Analytics, Quality Management, Claims and others, execute on the development and management of Provider KPI dashboard reporting.
• Maintain compliance for Network adequacy, including Medicare requirements and the NY Medicaid PNDS submissions.
• Develop and maintain Provider Relations and Credentialing activity reporting.
• Identify opportunities for operational process improvements, increasing automation, reducing rework, and bringing about operational efficiencies to support an optimal Network Operations environment.
• Act as a subject matter expert on Provider Data Management goals and strategies for operational excellence.
• Develop PowerPoint Slide decks/self-serve tools to support QBRs and Operations meetings based on external KPI’s.
• Program Management of Site Visits, Access & Availability (A&A), and Education tracking
• Development and Coordination of all Provider P&Ps, Quality Committee submissions and Regulatory narratives., ensuring adherence to all Legislative, Regulatory and Contractual requirements.
• Fosters a culture of accountability that emphasizes people and performance management, coaching and development and employee engagement.

• Master of Public Administration (MPA) or Master of Public Health (MPH) degree required; and
• Minimum 5 years of relevant healthcare industry experience in a provider network operations role; or
• A satisfactory equivalent combination of education, training, and minimum 10 years of relevant healthcare industry experience in a provider network management and Provider Network Operations environment.
• Must have excellent healthcare financial and operational data analysis and reporting skills.
• A demonstrated track record of operational trend reporting in the day-to-day business of a high-volume. operations using current and new technology, achieving cost benefits and service excellence.
• Experience creating dashboards, reporting metrics, synthesizing, and delivering key information with key stakeholders.

Professional Competencies

• Integrity and Trust
• Customer Focus
• Functional/Technical skills
• Written/Oral Communication
• Proven track of building cross-functional relationships
• Excellent verbal and written communications skills with demonstrated ability to communicate, present, and influence both credibly and effectively at all levels of an organization, including executive and Clevel.
• Demonstrated ability to lead and develop people
• Demonstrated self-starter, strategic thinker, and ability to work collaboratively in a team atmosphere.
• Adapt quickly to change in an ever-changing environment.
• Adaptable quickly to change in an ever-changing environment.
• Strong business acumen, analytical and critical thinking

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