Provider Program Quality & Integration Consultant I/II
Capital District Physicians Health Plan Inc, DeWitt, NY, United States
Job Description
The Provider Program Quality & Integration Consultant facilitates the development and effective implementation of quality and incentive programs and contracts. This work directly impacts the Excellus clinical provider network and member populations. As an individual contributor, this role is a combination of researcher, consultant, strategist, and analyst that facilitates the successful execution of business strategy.
The incumbent builds vision, consensus, and commitment among stakeholders such as physicians, nurses, health system executives, quality leadership, vendor partner leadership, and community leaders using industry measurement methodologies, clinical best practice, and empirically sourced change management practices. This position serves as the subject matter expert in all aspects of quality improvement, measurement, and network implementation to increase efficiency and productivity while reducing waste and costs.
Essential Accountabilities
Level I
Develops, negotiates, administers, and maintains contracted quality improvement programs
Health plan quality goal and national measurement SME, including CMS, HEDIS, QARR, STAR, CAHPS measures
Data mining and analysis ability to formulate solutions and narrate program value stories
Process improvement, healthcare quality trend and project leadership SME
Locates and submits clinical evidence/best practice associated with program development and implementation to inform network and vendor proposals
Evaluates and reports quality program statuses and outcomes to determine impact of interventions using direct and proxy measurement and validation
Develops process standardization and workflow recommendations for quality programs and contracts in development
Supports and executes network and vendor programs which improve the quality, safety, and accessibility of care while lowering costs through implementation of strategic initiatives
Ensures program alignment with organizational goals and existing provider network relationships
Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies' mission and values, adhering to the Corporate Code of Conduct, and leading the Lifetime Way values and beliefs
Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures
Regular and reliable attendance is expected and required
Performs other functions as assigned by management
Level II (in addition to Level I Accountabilities)
Manages network and vendor engagements including vendor selection, contract negotiation, contract process oversight, and vendor implementation with other key business areas as appropriate
Provides oversight and direction in managing day-to‑day operations of complex projects and programs, including associated reporting while remaining compliant with mandates
Independently develops novel program proposals focused on quality improvement and cost savings utilizing network relationships and competitive market analysis
Provides recommendations, builds collaboration, and focuses team efforts through regular presentation; takes the initiative to interface with matrixed groups related to program development and implementation
Takes a systematic delivery view of the portfolio: identifying, developing, and managing cross‑dependent projects to increase efficiency and effectiveness while addressing barriers and risks
Is a primary contact for matrixed implementation of initiatives, including oversight of strategic programs that involve external organizations
Educates, mentors, and coaches members of the program team throughout the course of development and implementation to ensure the goals of the program are realized in alignment with its strategic mission and vision
Works closely with those accountable for driving clinical changes from both the delivery system and the Health plan to obtain feedback regarding the viability of programs and provider needs
Participates in critical activities such as strategic planning and thought leadership at departmental, cross‑functional and organization level
Minimum Qualifications
NOTE: We include multiple levels of classification differentiated by demonstrated knowledge, skills, and the ability to manage increasingly independent and/or complex assignments, broader responsibility, additional decision making, and in some cases, becoming a resource to others. In addition to using this differentiated approach to place new hires, it also provides guideposts for employee development and promotional opportunities.
All Levels
Minimum of 5 years of related work experience
Bachelor's degree in Nursing, Business or Healthcare Administration, Analytics, Project Management, or related fields preferred
Applied knowledge of quality improvement, accreditation, or regulatory compliance
Demonstrated quality principles, proficiency in problem solving and quality tools/techniques
Strong communication skills required, including ability to effectively communicate verbally and in writing, internally and externally, and across the organization and all levels of management
Strong facilitation skills
Strong understanding and application of vendor management skills
Skilled speaker and presenter experienced in defining, socializing, and sustaining change across diverse groups
Very strong analytical and business process development skills
Demonstrated experience in project leadership or principles such as Lean Six Sigma, CPC, process mapping, tests of change, or PDSA cycles
Demonstrated experience communicating with senior management in various formats, informal discussions, written reports, scheduled meetings, and executive level presentations
Knowledge and experience working in the healthcare, health insurance or similar industry
Level II (in addition to Level I Qualifications)
Three years of additional related experience
PMI Certification/PMP Certification or other project management certification preferred
Demonstrated knowledge of network and vendor experience in relation to quality
Prior program implementation experience preferred
Prior network and product experience
Physical Requirements
Ability to work while sitting and/or standing at a workstation viewing a computer and using a keyboard, mouse and/or phone for three (3) or more hours at a time
Ability to travel across the Health Plan service region for meetings and/or trainings as needed
In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position.
Equal Opportunity Employer
Compensation Range(s)
Level I: Grade E3 – Minimum $62,400, Maximum $106,929
Level II: Grade E5 – Minimum $71,880, Maximum $129,384
The salary range indicated in this posting represents the minimum and maximum of the salary range for this position. Actual salary will vary depending on factors including, but not limited to, budget available, prior experience, knowledge, skill and education as they relate to the position's minimum qualifications, in addition to internal equity. The posted salary range reflects just one component of our total rewards package. Other components of the total rewards package may include participation in group health and/or dental insurance, retirement plan, wellness program, paid time away from work, and paid holidays.
Please note: There may be opportunity for remote work within all jobs posted by the CDPHP Talent Acquisition team. This decision is made on a case‑by‑case basis.
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.
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The Provider Program Quality & Integration Consultant facilitates the development and effective implementation of quality and incentive programs and contracts. This work directly impacts the Excellus clinical provider network and member populations. As an individual contributor, this role is a combination of researcher, consultant, strategist, and analyst that facilitates the successful execution of business strategy.
The incumbent builds vision, consensus, and commitment among stakeholders such as physicians, nurses, health system executives, quality leadership, vendor partner leadership, and community leaders using industry measurement methodologies, clinical best practice, and empirically sourced change management practices. This position serves as the subject matter expert in all aspects of quality improvement, measurement, and network implementation to increase efficiency and productivity while reducing waste and costs.
Essential Accountabilities
Level I
Develops, negotiates, administers, and maintains contracted quality improvement programs
Health plan quality goal and national measurement SME, including CMS, HEDIS, QARR, STAR, CAHPS measures
Data mining and analysis ability to formulate solutions and narrate program value stories
Process improvement, healthcare quality trend and project leadership SME
Locates and submits clinical evidence/best practice associated with program development and implementation to inform network and vendor proposals
Evaluates and reports quality program statuses and outcomes to determine impact of interventions using direct and proxy measurement and validation
Develops process standardization and workflow recommendations for quality programs and contracts in development
Supports and executes network and vendor programs which improve the quality, safety, and accessibility of care while lowering costs through implementation of strategic initiatives
Ensures program alignment with organizational goals and existing provider network relationships
Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies' mission and values, adhering to the Corporate Code of Conduct, and leading the Lifetime Way values and beliefs
Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures
Regular and reliable attendance is expected and required
Performs other functions as assigned by management
Level II (in addition to Level I Accountabilities)
Manages network and vendor engagements including vendor selection, contract negotiation, contract process oversight, and vendor implementation with other key business areas as appropriate
Provides oversight and direction in managing day-to‑day operations of complex projects and programs, including associated reporting while remaining compliant with mandates
Independently develops novel program proposals focused on quality improvement and cost savings utilizing network relationships and competitive market analysis
Provides recommendations, builds collaboration, and focuses team efforts through regular presentation; takes the initiative to interface with matrixed groups related to program development and implementation
Takes a systematic delivery view of the portfolio: identifying, developing, and managing cross‑dependent projects to increase efficiency and effectiveness while addressing barriers and risks
Is a primary contact for matrixed implementation of initiatives, including oversight of strategic programs that involve external organizations
Educates, mentors, and coaches members of the program team throughout the course of development and implementation to ensure the goals of the program are realized in alignment with its strategic mission and vision
Works closely with those accountable for driving clinical changes from both the delivery system and the Health plan to obtain feedback regarding the viability of programs and provider needs
Participates in critical activities such as strategic planning and thought leadership at departmental, cross‑functional and organization level
Minimum Qualifications
NOTE: We include multiple levels of classification differentiated by demonstrated knowledge, skills, and the ability to manage increasingly independent and/or complex assignments, broader responsibility, additional decision making, and in some cases, becoming a resource to others. In addition to using this differentiated approach to place new hires, it also provides guideposts for employee development and promotional opportunities.
All Levels
Minimum of 5 years of related work experience
Bachelor's degree in Nursing, Business or Healthcare Administration, Analytics, Project Management, or related fields preferred
Applied knowledge of quality improvement, accreditation, or regulatory compliance
Demonstrated quality principles, proficiency in problem solving and quality tools/techniques
Strong communication skills required, including ability to effectively communicate verbally and in writing, internally and externally, and across the organization and all levels of management
Strong facilitation skills
Strong understanding and application of vendor management skills
Skilled speaker and presenter experienced in defining, socializing, and sustaining change across diverse groups
Very strong analytical and business process development skills
Demonstrated experience in project leadership or principles such as Lean Six Sigma, CPC, process mapping, tests of change, or PDSA cycles
Demonstrated experience communicating with senior management in various formats, informal discussions, written reports, scheduled meetings, and executive level presentations
Knowledge and experience working in the healthcare, health insurance or similar industry
Level II (in addition to Level I Qualifications)
Three years of additional related experience
PMI Certification/PMP Certification or other project management certification preferred
Demonstrated knowledge of network and vendor experience in relation to quality
Prior program implementation experience preferred
Prior network and product experience
Physical Requirements
Ability to work while sitting and/or standing at a workstation viewing a computer and using a keyboard, mouse and/or phone for three (3) or more hours at a time
Ability to travel across the Health Plan service region for meetings and/or trainings as needed
In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position.
Equal Opportunity Employer
Compensation Range(s)
Level I: Grade E3 – Minimum $62,400, Maximum $106,929
Level II: Grade E5 – Minimum $71,880, Maximum $129,384
The salary range indicated in this posting represents the minimum and maximum of the salary range for this position. Actual salary will vary depending on factors including, but not limited to, budget available, prior experience, knowledge, skill and education as they relate to the position's minimum qualifications, in addition to internal equity. The posted salary range reflects just one component of our total rewards package. Other components of the total rewards package may include participation in group health and/or dental insurance, retirement plan, wellness program, paid time away from work, and paid holidays.
Please note: There may be opportunity for remote work within all jobs posted by the CDPHP Talent Acquisition team. This decision is made on a case‑by‑case basis.
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.
#J-18808-Ljbffr