VP - Performance Improvement
Apply NowCompany: UHS
Location: Reno, NV 89502
Description:
Responsibilities
Prominence Health is a value-based care organization bridging the gap between affiliated health systems and independent providers, building trust and collaboration between the two. Prominence Health creates value for populations and providers to strengthen integrated partnership, advance market opportunities, and improve outcomes for our patients and members. Founded in 1993, Prominence Health started as a health maintenance organization (HMO) and was acquired by a subsidiary of Universal Health Services, Inc. (UHS) in 2014. Prominence Health serves members, physicians, and health systems across Medicare, Medicare Advantage, Accountable Care Organizations, and commercial payer partnerships. Prominence Health is committed to transforming healthcare delivery by improving health outcomes while controlling costs and enhancing the patient experience.
Learn more at: https://prominence-health.com/
Job Summary: The Vice President (VP), Performance Improvement provides strategic leadership in the planning, development, implementation and execution of all aspects of a robust Risk Adjustment and STARS/HEDIS Program across Prominence Health Plan's (PHP) Medicare Advantage and Commercial lines of products. The objective of this position is to ensure compliance with CMS coding and documentation requirements in order to optimize clinical quality and revenue opportunities for Prominence Health Plan as well as to oversee of the comprehensive quality measurement initiatives such as HEDIS and STARS, including reporting and compliance maintenance.
Key responsibilities include optimizing PHP revenue opportunities by ensuring members receive appropriate medical care that is accurately coded so that the members' risk scores are optimized and compliant with regulatory reporting standards. The VP oversees all aspects of the plan's HEDIS operations including measure improvement programs, data integrity, chart retrieval and abstraction efforts, audit compliance, and annual submission or rates as well as identifies strategies to improve performance across all STARS/HEDIS measures. The VP has programmatic oversight and responsibility for achieving all risk adjustment, quality, and member satisfaction performance goals of the Prominence Care Centers. The VP works closely with clinical and business leaders and oversees the development and implementation of population health and quality improvement initiatives aligned with PHP's clinical, business, quality measurement, and improvement strategies.
Must work collaboratively with other PHP departments, including Actuarial, IS, Legal, Health Services, Network Management, Quality Improvement and others to manage the risk adjustment and STARS process. Must develop or purchase tools that will result in leveraging information to manage member analytics in order to more effectively direct resources and activities to meet risk adjustment and STARS objectives. In carrying out these responsibilities, The VP works closely with external vendors and consultants, runs outsourced health risk assessment programs, develops training programs & tools to address the educational needs of providers and non-clinical staff, assists in the development of analytic and reporting tools, and assists in the development of data collection systems and workflows to fulfill CMS and quality measurement requirements.
Benefit Highlights:
About Universal Health Services:
One of the nation's largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (UHS) has built an impressive record of achievement and performance. During the year, UHS was again recognized as one of the World's Most Admired Companies by Fortune; and listed in Forbes ranking of America's Largest Public Companies. Operating acute care hospitals, behavioral health facilities, outpatient facilities and ambulatory care access points, an insurance offering, a physician network and various related services located all over the U.S. States, Washington, D.C., Puerto Rico and the U nited Kingdom. www.uhs.com
Qualifications
Qualifications and Requirements:
EEO Statement
All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws.
We believe that diversity and inclusion among our teammates is critical to our success.
Avoid and Report Recruitment Scams
At UHS and all our subsidiaries, our Human Resources departments and recruiters are here to help prospective candidates by matching skill set and experience with the best possible career path at UHS
and our subsidiaries. During the recruitment process, no recruiter or employee will request financial or personal information (e.g., Social Security Number, credit card or bank information, etc.) from you via email. Our recruiters will not email you from a public webmail client like Hotmail, Gmail, Yahoo Mail, etc.
If you suspect a fraudulent job posting or job-related email mentioning UHS or its subsidiaries, we encourage you to report such concerns to appropriate law enforcement. We encourage you to refer to legitimate UHS and UHS subsidiary career websites to verify job opportunities and not rely on unsolicited calls from recruiters.
Prominence Health is a value-based care organization bridging the gap between affiliated health systems and independent providers, building trust and collaboration between the two. Prominence Health creates value for populations and providers to strengthen integrated partnership, advance market opportunities, and improve outcomes for our patients and members. Founded in 1993, Prominence Health started as a health maintenance organization (HMO) and was acquired by a subsidiary of Universal Health Services, Inc. (UHS) in 2014. Prominence Health serves members, physicians, and health systems across Medicare, Medicare Advantage, Accountable Care Organizations, and commercial payer partnerships. Prominence Health is committed to transforming healthcare delivery by improving health outcomes while controlling costs and enhancing the patient experience.
Learn more at: https://prominence-health.com/
Job Summary: The Vice President (VP), Performance Improvement provides strategic leadership in the planning, development, implementation and execution of all aspects of a robust Risk Adjustment and STARS/HEDIS Program across Prominence Health Plan's (PHP) Medicare Advantage and Commercial lines of products. The objective of this position is to ensure compliance with CMS coding and documentation requirements in order to optimize clinical quality and revenue opportunities for Prominence Health Plan as well as to oversee of the comprehensive quality measurement initiatives such as HEDIS and STARS, including reporting and compliance maintenance.
Key responsibilities include optimizing PHP revenue opportunities by ensuring members receive appropriate medical care that is accurately coded so that the members' risk scores are optimized and compliant with regulatory reporting standards. The VP oversees all aspects of the plan's HEDIS operations including measure improvement programs, data integrity, chart retrieval and abstraction efforts, audit compliance, and annual submission or rates as well as identifies strategies to improve performance across all STARS/HEDIS measures. The VP has programmatic oversight and responsibility for achieving all risk adjustment, quality, and member satisfaction performance goals of the Prominence Care Centers. The VP works closely with clinical and business leaders and oversees the development and implementation of population health and quality improvement initiatives aligned with PHP's clinical, business, quality measurement, and improvement strategies.
Must work collaboratively with other PHP departments, including Actuarial, IS, Legal, Health Services, Network Management, Quality Improvement and others to manage the risk adjustment and STARS process. Must develop or purchase tools that will result in leveraging information to manage member analytics in order to more effectively direct resources and activities to meet risk adjustment and STARS objectives. In carrying out these responsibilities, The VP works closely with external vendors and consultants, runs outsourced health risk assessment programs, develops training programs & tools to address the educational needs of providers and non-clinical staff, assists in the development of analytic and reporting tools, and assists in the development of data collection systems and workflows to fulfill CMS and quality measurement requirements.
Benefit Highlights:
- Loan Forgiveness Program
- Challenging and rewarding work environment
- Competitive Compensation & Generous Paid Time Off
- Excellent Medical, Dental, Vision and Prescription Drug Plans
- 401(K) with company match and discounted stock plan
- SoFi Student Loan Refinancing Program
- Career development opportunities within UHS and its 300+ Subsidiaries! More information is available on our Benefits Guest Website: benefits.uhsguest.com
About Universal Health Services:
One of the nation's largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (UHS) has built an impressive record of achievement and performance. During the year, UHS was again recognized as one of the World's Most Admired Companies by Fortune; and listed in Forbes ranking of America's Largest Public Companies. Operating acute care hospitals, behavioral health facilities, outpatient facilities and ambulatory care access points, an insurance offering, a physician network and various related services located all over the U.S. States, Washington, D.C., Puerto Rico and the U nited Kingdom. www.uhs.com
Qualifications
Qualifications and Requirements:
- Master's Degree in Business Administration, Finance, Health Care Administration, Management or related field preferred.
- At least seven years of health care experience working with Medicare and/or Commercial risk adjustment and STARS/HEDIS programs. Requires working knowledge of CMS risk adjustment methodologies and quality improvement measures.
- Ability to effectively communicate in English, both verbally and in writing.
- Knowledge of regulatory quality-based reporting and audit requirements;
- Proficiency in interpreting results and formulating recommendations/action plans;
- Ability to research and analyze state/federal regulations related to health insurance and healthcare;
- Demonstrated skills in critical thinking, problem-solving, and the analysis, interpretation and evaluation of complex information;
- Excellent computer skills. Microsoft Office Suite
- Personable and demonstrated ability to develop and maintain relationships at all levels.
- Well organized and demonstrate strong attention to the detail
- Ability to understand, present and analyze data.
- Strong verbal and written communication skills.
- Versatile and flexible. Inquisitive mind with strong analytical skills and the ability to do complex problem solving.
- Strong project management, meeting process and presentation skills.
EEO Statement
All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws.
We believe that diversity and inclusion among our teammates is critical to our success.
Avoid and Report Recruitment Scams
At UHS and all our subsidiaries, our Human Resources departments and recruiters are here to help prospective candidates by matching skill set and experience with the best possible career path at UHS
and our subsidiaries. During the recruitment process, no recruiter or employee will request financial or personal information (e.g., Social Security Number, credit card or bank information, etc.) from you via email. Our recruiters will not email you from a public webmail client like Hotmail, Gmail, Yahoo Mail, etc.
If you suspect a fraudulent job posting or job-related email mentioning UHS or its subsidiaries, we encourage you to report such concerns to appropriate law enforcement. We encourage you to refer to legitimate UHS and UHS subsidiary career websites to verify job opportunities and not rely on unsolicited calls from recruiters.