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As a community, the University of Rochester is defined by a deep commitment to Meliora - Ever Better. Embedded in that ideal are the values we share: equity, leadership, integrity, openness, respect, and accountability. Together, we will set the highest standards for how we treat each other to ensure our community is welcoming to all and is a place where all can thrive.

Job Location (Full Address):

135 Corporate Woods, Rochester, New York, United States of America, 14623

Opening:

Worker Subtype:

Regular

Time Type:

Full time

Scheduled Weekly Hours:

40

Department:

500448 Medical Home Data Coordinator

Work Shift:

UR - Day (United States of America)

Range:

UR URG 112

Compensation Range:

$70,197.00 - $105,295.00

_The referenced pay range represents the minimum and maximum compensation for this job. Individual annual salaries/hourly rates will be set within the job's compensation range, and will be determined by considering factors including, but not limited to, market data, education, experience, qualifications, expertise of the individual, and internal equity considerations._

Responsibilities:

GENERAL PURPOSE

Sr. Quality and Compliance Sp, PCMH promotes compliance with Patient Centered Medical Home (PCMH) standards throughout all Primary Care Network & academic practices, including HH, SMH and URMFG affiliated practices. This position advocates for using workflows and patient care practices that align with the standards and guidelines set by the National Committee for Quality Assurance NCQA -PCMH. This position also ensures that quality data and reporting meet NCQA requirements and is responsible for overseeing and prioritizing PCMH report requests.

The Sr. Quality and Compliance Sp, PCMH will remain current with PCMH standards, regulations, and guidelines and serve as a PCMH subject matter expert for UR Medicine. With minimal supervision, independent judgment and shared decision-making, this role is responsible for coordinating and submitting NCQA PCMH Annual Renewal application for all participating Primary Care Network Practices, & Academic Practices resulting in a successful submission and renewal each year. This role may consult on PCMH matters with UR Medicine affiliates.

This position reports directly jointly to the Primary Care Network Medical Director for Quality and Population Health and the Chief Administrative Officer for Primary Care.

ESSENTIAL FUNCTIONS

Compliance:

+ Develops and maintains documented processes and workflows as required by PCMH standards and guidelines.

+ Collaborates with primary care leaders and other key stakeholders to develop quality improvement initiatives and implementation at the practice level.

+ Keeps the PCN Executive Leadership Team updated on PCMH performance by highlighting achievements, identifying barriers, and providing recommendations for improvement.

+ Reports legal changes within the PCN, including acquisitions, mergers, closings, and provider changes to NCQA.

+ Collaborates with the URMC Office of Counsel to obtain proper documentation.

+ Monitor and supervises work of third-party consultants to ensure alignment with URMC principals for academic practices

+ Responsible for maintenance of accurate provider detail on NCQA portal (“provider update process”)

+ Serves as liaison between URMC and NCQA in the planning and implementation of PCMH programs

Data analytics:

+ Uses data analytics to evaluate performance with PCMH requirements, including a retrospective review of electronic medical records and data.

+ Performs rigorous data analysis across various sources (i.e. Epic, Tableau, SSRS, Mingle), exercising independent judgement to select relevant data for submission of PCMH.

+ Participate in reviewing reports to ensure alignment with HEDIS and CMS metric definitions to meet PCMH requirements.

+ Works closely with IT and the Central PCMH Team to devise solutions to improve data collection and reporting.

+ Advises on alternative data sources that could be used for PCMH applications

+ Oversees and coordinates access to Dashboards, Tableau, and other data sources for Affiliate Sites.

+ Provides feedback on PCMH reports. Identify efficiencies and optimizations to be implemented.

+ May participate in validation efforts.

+ Make recommendations for changes as needed.

+ Prioritize PCMH report requests and provide directive for correction when needed

+ Responsible for maintaining portfolio of PCMH reports to ensure accuracy, usability and alignment with PCMH requirements

Project Management:

+ Establishes goals and timelines for successfully completing the PCN’s PCMH annual renewal.

+ Develops agendas, meeting objectives, participant requirements and timelines for practice-level PCMH meetings.

+ Develops expectations and assesses compliance with PCMH activities.

+ Delegates appropriate tasks and assignments to Population Health Specialists, directing efforts to meet PCMH goals and deadlines.

+ Requests pertinent documentation from the health data coordinator and practice managers based on PCMH standards.

+ This ensures the timely collection and accuracy of documentation.

+ Evaluates and organizes information and data to ensure timely application submission.

+ Serves as the primary contact for NCQA PCMH randomized audits.

+ Leads PCN audit process with key stakeholders.

+ Ensure thorough documentation, compliance with standards, and successful audit outcomes through meticulous planning, coordination, and execution.

+ Collaborates with external third-party PCMH consultants on program requirements.

+ Provide work directive to PCMH & P4P Program Management Coordinators through dotted line reporting relationship

Training and Education:

+ Maintains a thorough understanding of PCMH standards, rules, and regulations.

+ Earns and maintains Certified Content Expert Certification through NCQA.

+ Serves as an internal contact for Primary Care Network regarding PCMH standards, regulations, workflows, and education.

+ Provides clinical context and knowledge as needed.

+ Develops and delivers training and educational materials for new staff on PCMH principles.

+ Informational presentations to the Health Data Coordinator and Practice Managers in preparation for annual submission or PCMH changes.

+ Conducts additional training and educational presentations may be required to introduce new concepts or workflows.

+ May consult with UR Medicine affiliates on PCMH and may provide training.

Program Leadership:

+ Be the primary point of contact to represent PCMH at URMC

+ Develop and execute program priorities with input from stakeholders at each site

+ Use analytical abilities to support identification, implementation and ongoing evaluation of programmatic areas of opportunity

+ Responsible for building and maintaining interdepartmental relationships

+ Manage relationship with third-party consultants as appropriate

+ Identify and mitigate areas of risk for lapsing in certification – communicate to key stakeholders

+ Provide input for system-wide workflows to ensure compliance with PCMH (i.e. eCheckin Screenings, SDoH, Centralized Referrals, Risk Scores etc.)

+ Foster strong relationships with leadership at each academic site to provide central PCMH support and advisement as needed

Other duties as assigned.

MINIMUM EDUCATION & EXPERIENCE

+ Bachelor degree Required

+ Registered Nurse (RN) Preferred

+ 5 years of experience in health care setting Required

+ or equivalent combination of education and experience Required

KNOWLEDGE, SKILLS AND ABILITIES

+ Experience with Epic Required

+ Proficient in Excel Required

+ Project Management Experience Required

LICENSES AND CERTIFICATIONS

+ PCMH-CCE Preferred

The University of Rochester is committed to fostering, cultivating, and preserving an inclusive and welcoming culture to advance the University’s Mission to Learn, Discover, Heal, Create – and Make the World Ever Better. In support of our values and those of our society, the University is committed to not discriminating on the basis of age, color, disability, ethnicity, gender identity or expression, genetic information, marital status, military/veteran status, national origin, race, religion, creed, sex, sexual orientation, citizenship status, or any other characteristic protected by federal, state, or local law (Protected Characteristics). This commitment extends to non-discrimination in the administration of our policies, admissions, employment, access, and recruitment of candidates, for all persons consistent with our values and based on applicable law.

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Learn. Discover. Heal. Create.

Located in western New York, Rochester is our namesake and our home. One of the world’s leading research universities, Rochester has a long tradition of breaking boundaries—always pushing and questioning, learning and unlearning. We transform ideas into enterprises that create value and make the world ever better.

If you’re looking for a career in higher education or health care, the University of Rochester may offer the perfect opportunity for your background and goals

At the University of Rochester, we are committed to fostering, cultivating, and preserving an inclusive and welcoming culture and are united by a strong commitment to be ever better—Meliora. It is an ideal that informs our shared mission to ensure all members of our community feel safe, respected, included, and valued.