CAHPS Director

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 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 CAHPS Director defines and strategically formulates the organization’s quality improvement (QI) strategy for member experience metrics, as defined by NCQA and the NYS DOH. The position designs, implements and evaluates QI initiatives and/or data mining/research activities to improve CAHPS performance while working closely with the Customer Experience, Customer Service, Provider Network Operations, Medical Management and other teams to ensure resources are properly allocated to address performance deficiencies in key metrics. The Director is responsible for ensuring a quality strategy that is organized, coordinated, and measured, and designed to maximize performance in the state’s Quality Incentive Award (QIA) and CMS’ Medicare Star Ratings programs. The Director will supervise 1 FTE, the CAHPS/HOS Lead. To succeed in the role, candidates must be:

• self-motivated and able to work in a fast-paced, dynamic work environment
• possess strong attention to detail and technical abilities
• organized and able to meet deadlines
• demonstrate strong communication skills

• Defines and strategically formulates MetroPlusHealth’s quality improvement (QI) strategy for CAHPS metrics and supports the organizational goal to provide top-tier experience to members. Effectively and efficiently manages all QI strategy projects.
• Holds all internal stakeholders accountable for their respective CAHPS-related outcomes and will provide summary of outcomes and deliverables to the Executive Leadership at least quarterly.
• With the CAHPS/HOS Lead, designs, implements, and evaluates CAHPS surveys (e.g., regulatory surveys, key driver surveys, post-appointment ‘pulse’ surveys, mock surveys) to drive internal/external QI activities. Schedule mock surveys such that resulting data can be actioned prior to the related regulatory surveys.
• Drives data analytics efforts to identify improvement areas, understand marketplace and member/provider behaviors, perform root-cause analysis, and evaluate program effectiveness for CAHPS metrics. Able to provide innovative solutions based on industry wide best practices to critical problems and foster a like-minded approach amongst direct and indirect reports.
• Synthesizes multiple data streams, e.g., survey, utilization, complaints, appeals/grievances to develop a comprehensive view of the ‘member experience’ and identify high-risk members, i.e., ‘likely dissatisfied’. Analyzes access ‘bottlenecks’ in the provider network and partners with internal departments to proactively resolve. Assists in ensuring the provider directory is complete and accurate for both members and referring providers.
• Identifies industry trends to ensure QI strategy keeps pace with planned or expected changes to state/federal quality reporting programs.
• Key player in developing member and provider incentives for CAHPS metrics.
• Aligns internal/external action plans and workstreams with the organization’s overarching CAHPS strategy
• Evaluates effectiveness of such programs and improvements as needed.
• Monitors and manages Quality and Performance Improvement Project(s) and other regulatory projects, including documenting performance indicators, outcomes measures, process measures, procedures, interventions, and reporting to CMS/DOH/IPRO.
• Evaluates the effectiveness of existing operational metrics, developing new metrics as necessary, to better assess the performance of organization in achieving CAHPS targets. Tracks and reports on initiative progress at all appropriate levels of the organization, creating or joining the necessary workgroups to do so.
• Communicate CAHPS strategy and results to quality committees or workgroups, such as the Health Status Improvement Team (HSIT) Workgroup.
• Assist in the maintenance of contract to administer the regulatory CAHPS survey and other mock surveys.
• Participate in special projects as needed.

• Master’s Degree in Healthcare Administration, Public Health or any analytical field including Applied Mathematics and Statistics, Finance, Health Care Management or related field.
• Must have a minimum of 10 years’ experience in the health care field. At least 5 years’ working with CAHPS or other ‘member experience’ metrics.
• Expert knowledge on CAHPS measures. Knowledge of HEDIS, QARR, Star reporting processes strongly preferred.
• Superior oral, written and communications skills. Ability to understand and communicate data to varied audiences.
• Solid analytical and logical skills paired with strong attention to details.
• Must be a versatile, quick learner, who is open to change and enjoys the challenge of unfamiliar tasks.
• Superior project management and documentation skills.
• Must be action oriented, producing results on projects that require risk taking with minimal planning, while keeping self-control during high activity periods.
• Ability to function well independently and in team setting.
• Must be able to make effective and timely decisions by organizing information in a useful manner and orchestrating multiple activities at once to accomplish the goal.
• Must work effectively with others, fostering open dialogue, accountability, and common mindsets within the team.
• Must have integrity, fostering an honest and trusting relationship with co-workers and management, never compromising the Plan, other employees, or self for personal gain.
• Must seek to continuously improve processes for the benefit of the customer by taking personal responsibility for the resolution of customer services.

Professional Competencies

• Must be proficient in Microsoft Word, PowerPoint, Excel, and Access.
• Demonstrated interpersonal/verbal communication skills.
• Ability to lead and manage others.
• Experience with and proficient in data analysis. Working knowledge of relational database and statistical analyses is a plus.
• Must be familiar with and have a working knowledge with QI process improvement methodology strategies including but not limited to PDSA and DMAIC.
• Must be an expert in CAHPS, HEDIS, QARR requirements.
• Must possess analytical skills to collect, organize and present data in a clear and concise manner.
• Ability to assess all work and prioritize as necessary to meet reporting timeframes and deadlines.
• Demonstrated problem solving skills.
• Ability to work in a fast-paced environment with changing priorities.