Directly leads day-to-day activities related to health plan quality assessments. Provides oversight, guidance, and leadership to Research Coordinator IIs on PIP deliverables, while mentoring first and second reviewers to enhance their evaluation skills and knowledge of PIPs, quality improvement principals, and implementation science. Leads technical assistance calls with the health plans and conducts the third and final review of the PIP evaluations. Designs and conducts interviews of health plan personnel, reviews health plan documents, assesses health plan compliance with state and federal regulations, and evaluates quality improvement programs and performance improvement projects.
Creates efficient and effective structures and processes to facilitate the successful completion of QI-related deliverables. Leads the interpretation and administration of policies and procedures within assigned areas of responsibility. Makes recommendations for developing, revising, and implementing program policy and procedures. Works with faculty and team staff to develop innovative research projects focused on healthcare quality topics of interest to the State of Texas, and that coincide with national, state, and ICHP research priorities. Conducts qualitative analyses of QI deliverables and generates written reports for key stakeholders.
Develops and prepares content for webinars, workshops, health plan learning collaborative, web portal, and other avenues for communicating QI strategies to health plans. Reviews and identifies relevant literature on implementation science, rapid-cycle PDSA, health learning systems, and other quality improvement methods. Applies findings from literature to the PIP process to develop presentations for workshop that help the MCOs/DMOs enhance performance and understanding of methods that will improve the quality of the PIPs.
Contributes to the design and coordination of evaluation research studies, including the development of methodologies, instruments, and other tools. Writes health plan assessment reports.
Develops PIP topics in collaboration with colleagues, HHSC, and health plans. Identifies current state and national initiatives addressing the Medicaid population and key areas of importance to the State based on the State’s quality strategy to suggest focus areas for the PIPs. Examines and assesses MCOs and DMOs performance on measures that are aligned with the State quality strategy and with current Medicaid initiative. Based on these assessments, makes meaningful recommendations for PIP topics that address Medicaid initiatives and the State quality strategy while also opportunities for improvement among the MCOs and DMOs by line of business.
Performs related duties as required or deemed appropriate to the accomplishment of the successful completion of QI deliverables and projects.