• Develop and maintain positive business relationships with external organizations, vendors, regulatory agencies and develop

and present reports during plan and public meetings with the regulators (CMS, DOH, DFS, IPRO) for the Plan when addressing
performance and quality improvement projects.

• Generate and update Quality Management regulatory reports to maintain compliance with relevant federal, state and

accreditation regulations and standards some of which support activities that address HARP, Behavioral Health, the
enterprise’s Quality Committee structure and metrics that influence HEDIS, QARR, HOS, and Stars.

• Lead the coordination, development, tracking, and analysis of actions and outcomes against the goals for assigned

regulatory and accreditation mandated quality performance improvement project(s) across all lines of business,
reporting requirements, and corrective action plans required by CMS, NYSDOH, DFS and other regulators, NCQA, and
employer groups such as the FEHB, with the goal to achieve and maintain compliance.

• Implement projects and action plans that address regulatory, accreditation, and employer group mandated

performance improvement project(s) reporting requirements.

• Establish a cooperative group and/or collaborate with internal and external partners to develop initiatives, address

root causes and barriers, develop and implement activities towards meeting state or national benchmarks such as
Medicaid state-wide average, or CMS benchmarks, or FEHB goals etc.

• Develop and maintain applicable data collection and reporting including submitting reports timely to appropriate

parties for review and final submission. Establish cross-department workgroups to address progress towards
established goals.

• Initiate, monitor and track projects through marketing and communication designated process, ensuring that project

timelines are adhered to and all projects are reviewed and approved by necessary and appropriate individuals.

• Analyze the impact of the activities examining barriers, root causes, developing actions, and prepare reports. Present

reports to the appropriate internal workgroups and committees.

• Address directly with regulators the corrective action plans, discussing plans and progress, modifying goals and

outcomes with regulators.

• Regularly monitor regulatory or government policy/methodology updates and industry news and assess and address

potential impact from changes related to the product line. Incorporate updates as needed.

• Prepare reports and present the activities and analysis to the to the appropriate agencies such as DOH, IPRO, or

internally to the Quality Committees.

• Create and update Quality Management regulatory reports to maintain compliance with relevant federal, state and

accreditation regulations and standards some of which support activities that address HARP, Behavioral Health, the
enterprise’s Quality Committee structure and metrics that influence HEDIS, QARR, HOS, and Stars.

• Craft clinical policy guidelines using national and state written guidance.
• Establish and maintain role as a key contact with the regulators (CMS, DOH, DFS, IPRO) for the Plan when addressing

performance and quality improvement projects. Serve as primary contact/resource for quality based regulatory and
accreditation reporting for all product lines required by CMS, NYS DOH, IPRO, as well as employer groups such as FEHB.

• Participate in community collaboratives as a means to address member health and satisfaction with care and with

health status improvement within the community at large and to facilitate process improvement.

• Present results of activities to the regulators and collaboratives.
• Other related tasks/projects as directed or required.