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Job Details

Lead QM Administrative Specialist

Job Ref: 56226
Category: Quality Assurance
Location: 160 Water St. #3, New York, NY
Job Type: Regular
Employment Type: Full-Time
Hire In Rate: $60,000.00
Salary Range: $60,000.00 - $68,000.00

Marketing Statement

MetroPlus Health Plan 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, MetroPlus’ network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlus has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life. 

Position Overview

The primary function of the Lead QM Administrative Specialist is to manage routine and non-routine functions and projects for Quality Management and its teams (Leadership, Quality Improvement, Quality Review Operations, Medicare Stars, Business Process Oversight) including management of all budget and financial aspects of Quality Management.  Initiate process improvement opportunities utilizing Lean Six Sigma methodology to improve operations within the Quality Management Department, to maintain and support quality management processes.  This position will oversee all administrative aspects of the Quality Management Committee including scheduling, minutes, report collection, documentation and presentations.  The incumbent requires initiative, organizational abilities and detailed knowledge of MetroPlus and Quality Management goals, policies and procedures to enact change and lead efficient productivity.  The Lead QM Administrative Specialist applies knowledge of best practices and makes judgments from work experience about priorities and executes processes and projects to meet timelines to ensure the quality of projects output.

Job Description

  • Manage all financial and budget applications for Quality Management cost center, including: managing the annual budget and budget process, analysis and monitoring of monthly variance reports, all departmental invoice processing and order placements, monthly accrual process, medical expense reporting and processes, and quarterly forecasting.  Responsible for communicating any variances or issues to the AED, Quality Management and other Quality Management Directors.  Act as a liaison between Accounting/Finance and Quality Management. 
  • Track budgeted positions in QM and assists with and tracks position fulfillment. 
  • Manage the development and ongoing maintenance of the Quality Management Committee (QMC) administrative functions including report development to the Quality Assurance Committee (QAC) of the Board by collecting, analyzing and reporting data from various data sources; applies analytical skills to identify areas that are variances and not on trend.     ·         Investigate and coordinate any action items requested by the Quality Management Committee and the Quality Assurance Committee of the Board.  Under direction from QM Directors develops other Quality Management reports to satisfy reporting requirements and requests from the Quality Assurance Committee of the Board, including but not limited to HEDIS reporting and presentations, QARR reporting and presentations, Quality Management Dashboard, etc.  This position records minutes for the QMC and QAC and coordinates the preparation of all documents for Committee presentation and maintains Committee Work Plans. 
  • Manage the monthly QM team meeting agenda and records minutes and other meetings as needed by management. 
  • Manage QM’s part of corporate driven projects and coordinate corporate activities for the Quality Management Department.  Manage the Quality Management SharePoint site and other sub-sites as applicable; act as QM Departments’ SharePoint subject matter expert to provide guidance and assistance to quality management team members to meet departmental goals, including but not limited to information sharing, reporting, and project tracking, record-keeping.  Develop and maintain Quality Management Department specific documentation such as Business Unit Recovery Plan, organizational charts, phone lists, goals tracking grid, emergency process, job descriptions, etc.   
  • Administrative functions of this position include but is not limited to:   payroll-checks and timesheets for Quality Management including submitting to Payroll, maintains Department copies, distributes paychecks. 
  • Purchasing-monitors supplies inventory and completes purchase orders for supplies and equipment as approved by Director. 
  • Makes travel arrangements, prepares travel approval requests and reimbursement vouchers and submits signed forms to Finance for reimbursement or payment
  • Mail-opens, date stamps and distributes incoming mail; handles outgoing mail, including arrangements for express mail and hand deliveries;
  • Assists with scheduling meetings including all aspects of meeting set-up.
  • Develop and maintains QM training program for all newly on boarded QM team members and in conjunction with Team Director establishes team specific training documents/tools to be used by new team members and/or reference by all QM team members.   
  • Completes various tasks as assigned.  Tasks may range from filing to project tracking to conducting special projects.

Minimum Qualifications

  • Bachelor’s Degree in Health Care, Business or related field with a minimum of 4 to 6 years work experience in a managed care environment required. 
  • Highly proficient in Microsoft Word, Excel, PowerPoint, Visio and SharePoint required; knowledge of Microsoft Access a plus. 
  • Proven leadership; experience in managing multiple projects and changing priorities to meet deadlines. 
  • Must be familiar with basic process improvement methodology (PDSA and DMAIC processes). 
  • Six Sigma Yellow Belt or Lean training highly preferred.
  • Must be action oriented, producing results on projects that require risk taking with minimal planning, while keeping self-control during high activity periods. 
  •  Must be a versatile, quick learner who is open to change and enjoys the challenge of unfamiliar tasks. 
  • Must be able to perform job duties as an independent, self-motivating professional and as a team player with organizational skills sufficient to set own priorities, plan project scope and facilitate progress. 
  • Demonstrated leadership skills with the ability to listen, delegate, motivate and direct others effectively to complete projects and tasks. 
  • Strong organizational skills, including time and project management. 
  • Excellent oral and written communication and presentation skills. 
  • Excellent interpersonal skills with the ability to interact with all levels of management and staff. 
  • Independent decision making as appropriate. 
  • Critical thinking and analytical capabilities in identifying opportunities for improvement. 
  • Project management skills necessary for tracking progress and deliverables of projects. 
  • Solid analytical skills and logical skills paired with a strong attention to detail in order to collect, analyze, organize and report data in a clear concise manner. 
  • Must exercise discretion and maintain confidentiality.

Licensure and/or Certification Required: 

  • Yellow Belt or Lean Certification a plus

Professional Competencies

  • Integrity and Trust
  • Customer Focus
  • Functional/Technical sills
  • Written/Oral Communication