The Regulatory Quality Specialist will be primarily responsible for regulatory, and compliance needs of the ACO across the network and system and will be primarily responsible for the success of the West Virginia Health Network Medicare ACO across the new and fast-growing regions of our network. They will lead our Medicare risk contracts toward success by excelling across many dimensions, but most importantly through: (1) vision-setting for growth and project managing new operational initiatives that serve our population, (2) drawing insights from modeling and ad-hoc analyses to generate and implement high-value recommendations and (3) being a reliable policy knowledge expert on evolving CMS programs for the WVHN team.

Responsibilities

• Assist with ACO program oversight and submissions to CMS • Responsible for the implementation and rollout of the policy and contractual requirements for the MSSP ACO • Coordinates activities across operational teams, steering workgroups, and stakeholders. • Presents findings and recommendations for action to WVHN leadership and meetings including Board Meetings, and prepare knowledge sharing presentations on specific topics • Monitors, interprets, and reports on changes in performance, market trends, health care delivery systems and legislative initiatives which impact program efforts (e.g., CMS ACO regs,) • Facilitates and operationalizes relationships with external organizations including federal Medicare divisions (CMS and CMMI) and community strategic partners. • Interface with regulators to participate in and report back on program meetings, track and obtain responses on program questions, etc. • Performs analysis of quality, utilization performance by provider, practice, region, payer and in the aggregate in order to inform contract performance and to identify whether improvement efforts have impacted performance. • Collaborate with IT regulatory program manager to understand and accomplish needs of ACO. • Identify gaps and barriers that may impact shared savings and other payor reimbursement.

Knowledge, Skills & Abilities

Patient Group Knowledge (Only applies to positions with direct patient contact) The employee must possess/obtain (by the end of the orientation period) and demonstrate the knowledge and skills necessary to provide developmentally appropriate assessment, treatment or care as defined by the department’s identified patient ages. Specifically the employee must be able to demonstrate competency in: 1) ability to obtain and interpret information in terms of patient needs; 2) knowledge of growth and development; and 3) understanding of the range of treatment needed by the patients. Competency Statement Must demonstrate competency through an initial orientation and ongoing competency validation to independently perform tasks and additional duties as specified in the job description and the unit/department specific competency checklist. Common Duties and Responsibilities (Essential duties common to all positions) 1. Maintain and document all applicable required education. 2. Demonstrate positive customer service and co-worker relations. 3. Comply with the company's attendance policy. 4. Participate in the continuous, quality improvement activities of the department and institution. 5. Perform work in a cost effective manner. 6. Perform work in accordance with all departmental pay practices and scheduling policies, including but not limited to, overtime, various shift work, and on-call situations. 7. Perform work in alignment with the overall mission and strategic plan of the organization. 8. Follow organizational and departmental policies and procedures, as applicable. 9. Perform related duties as assigned.

Education

• Associate's Degree (Required) Understanding of healthcare payer programs, quality management, analytical skills, project management, compliance audits, facilitation, performance improvement.

Credentials

Work Schedule: Days

Status: Full Time Regular

Location: Northgate-400 Association Dr.

Location of Job: US:WV:Charleston

Talent Acquisition Specialist: Tamara B. Young tammy.young@camc.org