Quality Analyst

Join the Texas Health and Human Services Commission (HHSC) and be part of a team committed to creating a positive impact in the lives of fellow Texans. At HHSC, your contributions matter, and we support you at each stage of your life and work journey. Our comprehensive benefits package includes 100% paid employee health insurance for full-time eligible employees, a defined benefit pension plan, generous time off benefits, numerous opportunities for career advancement and more. Explore more details on the Benefits of Working at HHS webpage.

Brief Job Description:

The Texas Health and Human Services Commission (HHSC) Medicaid and CHIP Services (MCS) division seeks a highly qualified candidate to fill the position of Program Specialist VI. The Program Specialist VI reports to the Director of Quality Assurance and works as part of the Quality Assurance team within Quality and Program Improvement to improve health outcomes for Texas Medicaid and CHIP members. This position works under minimal supervision with extensive latitude for the use of initiative and independent judgment. The Program Specialist VI performs highly advanced consultative and technical work, including developing and implementing healthcare quality initiatives and evaluating the performance of contracted managed care organizations (MCOs). MCS is driven by its mission to deliver quality, cost-effective services to Texans. This position makes a significant contribution to MCS’s mission by using data-driven evidence-based approaches to hold Medicaid and CHIP MCOs accountable, ensure access to high-quality care, and drive quality-based innovation. The ideal candidate thrives in an environment that emphasizes: teamwork to achieve goals, excellence through high professional standards and personal accountability, curiosity to continuously grow and learn, critical thinking for effective execution, and integrity to do things right even when what is right is not easy.

Essential Job Functions (EJFs):

(40%) Develops and manages highly complex initiatives that evaluate and directly impact the performance of managed care organizations within the Medicaid and CHIP managed care programs. Plans, develops, coordinates, and implements quality related program and operational policy changes and initiatives. Develops recommendations for changes in programs and operational policies related to managed care and provides input on health quality initiatives.

(30%) Reviews and analyzes quality performance information including technical reports, datasets, and analyses completed by Texas’s external quality review organization. Works with other areas of MCS to review and improve understanding of quality metrics and reports and develops strategies to improve health plan performance. Provides consultative services and technical recommendations to MCOs on applicable topics and works with MCO staff to resolve technical and operational issues. Works closely with other program areas within HHSC, and associated vendors, to ensure operational processes and systems are coordinated. Works with staff and external stakeholders to identify risks/issues and develop mitigation strategies and solutions. Identifies quality gaps, improves reporting processes, tracks quality improvements and enhances current systems. Facilitates and participates in workgroups, setting goals and objectives and providing work products related to managed care programs and policy. Works collaboratively across MCS to identify innovative and effective solutions for clients and staff.

(20%) Prepares high-quality research, analyses, summaries, and other documents as assigned. Develops materials for preparation or follow up to workgroups and meetings conducted for internal and external stakeholders. Interprets agency rules and federal and state laws. Oversees compliance with program policies, procedures, statutes, and rules and takes corrective action if needed.  Develops reports, policies and procedures, and analysis tools.

(10%) Analyzes legislation related to quality initiatives delivered through managed care and suggests changes to legislative language. Implements quality-related legislative initiatives.

Knowledge, Skills and Abilities (KSAs):

Knowledge of:

• State and federal laws, regulations, and processes regarding Medicaid managed care.
• Healthcare quality concepts, quality assurance practices, and performance improvement monitoring. 

Skill in:

• Interpreting state and federal laws, regulations, and processes regarding Medicaid managed care.
• Project management.
• Leading workgroups, working with multiple stakeholders, and providing oversight to contracted vendors.
• Written and oral communication, including the ability to make public presentations, write technical information in an understandable format, and produce sophisticated research reports.
• Planning and organization. 

Ability to:

• Work collaboratively across MCS to accomplish objectives.
• Work cooperatively as a team member in a fast-paced, deadline-orientated environment.
• Balance team and individual responsibilities.
• Work independently and operate effectively within established guidelines and timeframes. 
• Perform work with a high degree of attention to detail.
• Analyze data to identify trends, problems, and issues.
• Analyze reports to verify data integrity.
• Develop and interpret statistical data charts, maps and tables.
• Develop and evaluate policies and procedures. 
• Solve complex problems.
• Implement creative solutions to problems.

Registrations, Licensure Requirements or Certifications:

N/A

Initial Screening Criteria:

Graduation from an accredited four-year college or university. Master's degree is preferred. Experience with healthcare quality or managed care. Experience leading projects or initiatives and addressing complicated issues or problems including analyzing policies, data and other complex information. Experience in communicating, including making presentations and preparing technical information in an understandable format for internal management and external publication. 

Additional Information:

N/A

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Active Duty, Military, Reservists, Guardsmen, and Veterans:

Military occupation(s) that relate to the initial selection criteria and registration or licensure requirements for this position may include, but not limited to those listed in this posting. All active-duty military, reservists, guardsmen, and veterans are encouraged to apply if qualified to fill this position. For more information please see the Texas State Auditor’s Job Descriptions, Military Crosswalk and Military Crosswalk Guide at Texas State Auditor's Office - Job Descriptions.

ADA Accommodations:

In compliance with the Americans with Disabilities Act (ADA), HHSC and DSHS agencies will provide reasonable accommodation during the hiring and selection process for qualified individuals with a disability. If you need assistance completing the on-line application, contact the HHS Employee Service Center at 1-888-894-4747. If you are contacted for an interview and need accommodation to participate in the interview process, please notify the person scheduling the interview.

Pre-Employment Checks and Work Eligibility:

Depending on the program area and position requirements, applicants selected for hire may be required to pass background and other due diligence checks.

HHSC uses E-Verify. You must bring your I-9 documentation with you on your first day of work. Download the I-9 Form

Telework Disclaimer:

This position may be eligible for telework.  Please note, all HHS positions are subject to state and agency telework policies in addition to the discretion of the direct supervisor and business needs.