Quality Regulatory Reporting Advisor

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Job Summary:

Key Position Details:

• 1.0 FTE (80 hours per two-week pay period)
• 8-hour day shifts
• No weekends
• Eligible for mileage reimbursement

Job Description:

Provides system-wide program leadership and support for ambulatory or hospital-based payer quality measure performance. Serves as a bridge between quality regulatory reporting and operational practice, translating regulatory requirements into actionable strategies that drive performance improvement across payer and reputational programs. Maintains knowledge and meeting reporting deadlines for current quality measures within value-based programs and contracts, including: Value Based Purchasing, Quality Payment Program, Bundled Payments, Commercial and Medicare Advantage programs, reputational programs (e.g. Leapfrog, USNWR) and other value-based payment models.

Principle Responsibilities

• Develops and implements quality regulatory reporting programs to align with the organization's goals and strategies
  • Serves as primary contact for external key stakeholders and maintains strategic partnerships with external organizations such as Minnesota Community Measurement, the MN Department of Health, DHS, and CMS.
  • Advises Allina Health internal clinical quality program committees, project teams and leadership on alignment with value-based contracts, external regulatory reporting requirements, and reputational programs.
  • Partners with Payor Relations & Contracting Team to understand and inform of the impact of value-based programs on operations and financial outcomes, including opportunity analysis and gap identification.
  • Understands government electronic medical record (EMR) requirements and application in alignment with quality reporting requirements for the Promoting Interoperability program.
• Measurement and Reporting
  • Interprets and applies measurement specifications and program requirements to ensure accurate validation and submission of data for ambulatory and hospital-based quality programs. (i.e., Value Based Purchasing, Quality Payment Program, MNCM, Alternative Payment Model data).
  • Meets regulatory quality reporting requirements for multiple entities in alignment with State and Federal agencies, value-based programs, and contracts.
  • Coordinates with necessary stakeholders and facilitates data validation, management and reporting within mandated deadlines.
• Performance Improvement and Strategy
  • Influences strategy by connecting measure performance to organizational goals, payer program requirements, and reputational outcomes.
  • Partners with clinical quality and clinical leaders to ensure regulatory standards are embedded into performance improvement initiatives.
  • Supports the development and implementation of action plans and improvement initiatives that align with system strategies, payer incentives, and reputational programs.
  • Provides foresight and strategic recommendations to leadership and clinical quality regarding emerging risks and opportunities in quality performance programs including tracking and communicating progress.
  • Collaborates with Performance Transformation and Payer Relations and Contracting on pay for performance programs that rely on clinical quality metrics.
  • Advises on performance targets and feasibility of clinical topics to optimize reimbursement
  • Participates in payer discussions regarding performance opportunities for Allina Health Group (e.g. HEDIS and Stars performance).
• Policy Interpretation, Input and Feedback
  • Analyzes and monitors state and federal legislative policy proposals regulating clinical quality programs and translates policy for operational understanding.
  • Monitors quality measurement activities occurring at national level (NCQA, NQF, CMS, eCQI, etc.) to anticipate and proactively communicate implications of measurement revisions.
  • Analyzes, monitors and provides feedback to federal, state and local agencies on the selection and development of quality program design elements and clinical quality measures in collaboration with Regulatory Affairs, Payment Policy, and Public Policy departments.
• Compliance
  • Identifies and elevates changes in legislative rules/statues or accreditation requirements
  • Provides support to development and implementation of new and innovative approaches to regulatory quality vulnerabilities.
  • Understands reporting requirements and data elements necessary to identify, support, or negate regulatory quality concerns.
• Other duties as assigned.

Required Qualifications

• Bachelor's degree in Nursing, Public Health, Pharmacy, Health Care Administration, Engineering and/or other health care related field
• 5+ years Healthcare experience in a related field
• 3+ years expert knowledge of healthcare regulatory quality requirements and ability to interpret technical specifications and translate into workflow and reporting logic

Preferred Qualifications

• Master's degree in Nursing, Public Health, Pharmacy, Health Care Administration, Engineering and/or other health care related field
• 2+ years Health Informatics experience

Physical Demands

• Sedentary:
• Lifting weight up to 10 lbs. occasionally, negligible weight frequently

Pay Range

Benefit Summary

Allina Health believes the best way to provide safe and compassionate care for our patients is by nurturing the passion of those who care for them. That's why we devote extraordinary resources to help you grow and thrive - not only as a professional but also as a whole person. When you join our team, you have access to a wealth of valuable employee benefits that support the total well-being - mind, body, spirit and community - of you and your family members.

Allina Health is all in on your well-being. Because well-being means something different to everyone, our award-winning program provides you with the resources you need to help you navigate your personal journey. This includes up to $100 in well-being dollars, dedicated well-being navigators, and many programs, activities, articles, videos, personal coaching and tools to support you on your journey.

In addition, Allina Health offers employee resources groups (ERGs) -- voluntary, employee-led groups that serve as a resource for members and organizations by fostering a diverse, inclusive workplace aligned with the organization's mission, values, goals, business practices, and objectives. Allina Health also engages employees in various community involvement and volunteering events.

Benefits include:

• Medical/Dental

• PTO/Time Away

• Retirement Savings Plans

• Life Insurance

• Short-term/Long-term Disability

• Paid Caregiver Leave

• Voluntary Benefits (vision, legal, critical illness)

• Tuition Reimbursement or Continuing Medical Education as applicable

• Student Loan Support Benefits to navigate the Federal Public Service Loan Forgiveness Program

• Allina Health is a 501(c)(3) eligible employer

*Benefit eligibility/offerings are determined by FTE and if you are represented by a union.