This position will provide project management, implement and oversee: the PCBHI/ICE process and quality measures; and policies developed through a quality assurance review process; assess quality and trends of ICE sites; provide evaluation of the service delivery system's effectiveness/efficiency.
Oversee the development and implementation of the evaluation plan for the PCBHI service delivery system and ICE sites including the coordination of state regulation and data requirements.
Provide and facilitate project management and coordination of service delivery evaluation, quality assurance, data management and utilization processes.
Develop or adapt an existing data collection tool(s) or data system(s) necessary to evaluate program effectiveness/impact and ICE performance.
Collect, manage, and convey data outcomes.
Facilitate and manage quality assurance and evaluation strategies for PCBHI quality and certification.
Facilitate consistent and on-going collection and monitoring of process and quality data and reports, and provide updates and recommendations to PCBHI state staff at least monthly. This includes monitoring and oversight of claims and non-claims data management.
Oversee and monitor data to ensure adherence to ICE standards and best practice care including the use of evidence-based practices, specific issues identified during a quality review, and other general program evaluation issues.
Works with State Integration Team (SIT), CMT/Relias, and OMPP, ICE Sites, and DMHA Quality Improvement team members to design a process for on-site quality improvement reviews of providers that are comprehensive and consistently implemented.
Collaborate with vendors, PCBHI State staff, EDW staff, CMT/Relias and ICE sites to facilitate the utilization of the CMT claims data and required non-claims data to inform the PCBHI process and provide quality performance and outcome measures. Establish a methodology to evaluate the data to provide process and quality performance and outcome measures.
Coordinate data collection and data analytic activities and results with PCBHI state staff, stakeholder group, EDW (data ware house), CMT and ICE sites to monitor and improve outcomes.
Facilitate analysis of CMT data reports, visual dashboard, monitor and report trends, benchmarks, substantial changes, and disseminate ICE provider reports as applicable.
Track work plan goals and timelines for sites pursuing ICE approval/certification status
Assist with ICE site certification and quality site visits and with issuance and monitoring of corrective plans.
Assist with formulating, interpreting, and compiling application materials for sites requesting ICE state approval/certification. (Desk Reviews)
Evaluate Provider ICE applications for compliance with federal and state regulations, rules and policies.
Assist with coordinating site visits and quality assurance reviews.
Collaborate with state technology systems to ensure data flow as needed for service delivery system and work to develop new data pathways that support integrated care.
Quality Reviewer of CMT/ProAct Medicaid Claims Data analysis and compile narrative reports highlighting program analysis of PCBHI ICE data.
Performs other duties as assigned.
Master’s degree in behavioral health, public health, health administration, data informatics or a related field; at least 3 years of related work experience in primary and/or behavioral healthcare service delivery, and/or data analytics/ program evaluation, and/or quality management preferred
Extensive project management skills, PMP preferred
Prior experience in a data analytic role preferred
In-depth knowledge of Microsoft Office Suite including Access
Successful candidates must have strong analytical skills, an inquisitive nature, and a strong track record of data collection/analysis, quality assurance reviews/audits, program evaluation, and creative problem solving.
Strong professional writing skills with the ability to concisely explain and tell a story using data.
Professional experience in population health and health care analytics
In-depth knowledge of primary care and behavioral health current trends, issues and topics preferred.
Requires the ability to create and deliver data/quality assurance presentations and recommendations to senior management and stakeholder groups
Requires the ability to access, analyze data and implement mechanisms to determine and monitor program effectiveness and efficiency.
Requires the ability to manage, plan and coordinate data/quality assurance development and implementation.
Requires strong problem solving skills.
Requires excellent written and verbal communication skills.
Requires in-depth knowledge of and ability to apply data analytics and informatics
Requires dependability, attention to detail, effective time management, multi-tasking skills, flexibility and adaptability to respond quickly and appropriately to issues and needs.
The ability to participate in in-state and/or out of state travel as required with an occasional overnight stay.