Job Description

Position Purpose: The HEDIS Program Manager interfaces and partners with the Quality leadership team and cross functional business partners (e.g. Risk Adjustment, Care Management, Utilization Management, Pharmacy) to provide expertise in how to drive operations to support quality performance for the Steward Organization’s lines of business and defined by the executive leadership.

  • This includes but is not limited to: HEDIS, custom state measure specification; project management of timeline objectives for audits and deliverables, year-round and seasonal medical records audits for Medicare/Medicaid plans, support analytic staff for clinical quality projects, support operations and analysis of applicable surveys, including opportunity identification, performance, and reporting to appropriate regulatory bodies and health plans, support applicable program design or enhancements, impact analysis, and program evaluation.
  • Project manages all aspects of collection of hybrid performance measure data and submission of this data to regulatory and accreditation bodies in an accurate, complete and timely fashion. Identify and implement all opportunities to collect this data year round
  • Creates and manages all aspect of related roadmaps and project plans, creates and implements training plans for auditors, over-reads auditors’ work, identifies and addresses auditors’ gaps in training/knowledge/skills, monitors and addresses auditors’ productivity issues. Using data, evidence-based techniques, and business (contractual) priorities, identify top opportunities to improve performance measure rates and communicate these in a clear and timely fashion to leadership
  • Provides project management support to QM, which may include creating and monitoring tracking mechanisms and monitoring improvement initiatives. Project manages all aspects of CMS Stars data collection, submission and improvement
  • This position may be located out of any of the following Health Choice offices: Flagstaff AZ, Phoenix AZ, Salt Lake City UT, Dallas TX, Needham MA
  • For candidates within commuting distance of those offices, remote work (telework) may be available based on business needs and job performance, after successful completion of an in-office training period

Education:

  • Bachelor's degree, RN, LPN, CPHQ, CCS, CCS-P, RHIT, RHIA, CDEO, CPMA, CPC, CRC, CHCA or similar credential

Years of Experience:

  • Seven (7) or more years of experience in health care quality focused roles that included medical record audits and/or performance metric i.e., HEDIS, Stars, or similar Significant experience in quality measurement, HEDIS, interpretation of claims data, medical record review

Specialized Knowledge:

  • Strong computer skills, i.e., using various software, including intermediate Excel skills (sort, filter, reformat data, etc.)
  • Strong analytic skills/ability to translate complicated data into useable information, including analysis of practice variation
  • Successful experience managing complex projects beginning to end with accountability for outcomes, demonstrated organizational and project management skills to manage complex projects through effective planning, tracking, and resource allocation to meet business objectives and timelines
  • Strong leadership and management skills; self-directed Ability to generate creative solutions

Application Instructions

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