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Position Summary

The Manager, HEDIS Program educates and serves as the HEDIS subject matter expert (SME). The Manager, HEDIS Program is responsible for coordinating, implementing, and executing HEDIS Program specific projects, and ensuring consistency with company strategy, commitments, and goals.

The HEDIS Administrator will assist with the communication of HEDIS results to internal and external stakeholders and coordinate efforts to drive improvements through quality improvement interventions (QIIs) projects (QIPs) across the health plan.

Job Description

Key Outcomes:

Manages the HEDIS Program including requirement gathering, creation of project plans and schedules, obtaining and managing resources, facilitating project execution, deployment, and closure.

Stays current with HEDIS guidelines and requirements, and best practices related to the execution of the HEDIS Roadmap.

Prepares accurate and timely reports on HEDIS performance for internal and external stakeholders, management, and regulatory bodies.

Maintains detailed project documentation in accordance with the NCQA HEDIS technical specifications, and HEDIS compliance audit standards, policies, and procedures.

Develops and implements strategies to validate supplemental data sources used in HEDIS operations, ensuring accuracy and reliability.

Works closely with vendors to ensure accuracy and validity of data obtained from external sources.

Creates and maintains a tracking system to document records of annual primary source verification activities, ensuring compliance with regulatory requirements.

Maintains a robust medical record review program to assess the quality of care provided by healthcare providers.

Develops and implements comprehensive auditing procedures to evaluate the accuracy and completeness of medical record documentation.

Analyzes medical record review findings and identifies opportunities for process improvement.

Manages the HEDIS team including coaching, professional growth and development, conducting performance evaluations and providing regular feedback to team members.

Education/Experience:

Bachelor's degree in health care or other related field; Master's Degree preferred

A minimum of five (5) years of experience in the health care industry, in HEDIS and/or quality improvement.

Experience in managed care health services environment.

Demonstrated knowledge of data collection, medical record review, and data extraction.

NCQA and HEDIS Experience.

Project management experience in a healthcare regulated or accredited environment.

Experience writing and editing regulatory policies and procedures as outlined by a governing body such as NCQA, TRICARE, or CMS.

Required License(s) and/or Certification(s):

Active and unrestricted RN licensure.

Skills/Knowledge/Competencies (Behaviors):

Demonstrates ability to manage teams and multi-disciplinary workgroups in achieving team objectives, without direct authority.

Ability to delegate responsibility, set priorities, and establish accountability.

Knowledge of CMS, DHA and NCQA quality programs.

Strong critical thinking, problem-solving and project management skills; ability to develop and implement solutions.

Ability to gather, interpret and present data to teams, senior leadership, and external partners.

Possesses ability to interpret and simplify communications of regulatory standards and remain up to date on changes to requirements.

Maintains broad knowledge of industry trends and developments.

Proactive approach and able to work independently, highly organized.

Excellent written and oral communication skills, able to discuss negative events with others in a supportive and non-punitive manner.

Ability to build collaborative relationships with multi-disciplinary teams supporting the achievement of objectives, without direct authority.

Inspires others toward the goal of continuous quality and safety improvement.

Manages multiple competing demands, able to prioritize and make sound decisions.

Competence with computers and business applications: Microsoft Outlook, Excel, Word, and Power Point.

Demonstrates understanding of and alignment with Martin's Point values.

There are additional competencies linked to individual contributor, provider, and leadership roles. Please consult with your leader to discuss additional competencies that are relevant to your position.

This position is not eligible for immigration sponsorship.

We are an equal opportunity/affirmative action employer.

Do you have a question about careers at Martin's Point Health Care? Contact us at: jobinquiries@martinspoint.org

Martin's Point Health Care

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