HEDIS Program Manager

Richmond VA 23233

Job Description

The HEDIS Program Manager develops and implements internal program(s) and member-facing initiatives geared toward increasing HEDIS (Healthcare Effectiveness Data and Information Set) rates and member satisfaction. Collaborates with care management, network, customer care and other internal health plan stakeholders. Works with external quality vendors driving HEDIS activities.

Essential Functions

  • Provides internal project management, leadership and facilitation of HEDIS related activities.
  • Ensures engagement of new and existing vendors for HEDIS related initiatives.
  • Provides assessment in partnership with care management, network, customer service and other internal teams of current programs and processes to better integrate HEDIS touch points that drive care gap closure.
  • Reviews literature to inform effective approaches in population health.
  • Develops documentation related to the design and implementation of HEDIS interventions, including, but not limited to telephone scripts, letters and mailers, program process flows, and state required forms for approval of events.
  • Develops and completes reports on intervention and program outcomes.

General Job Information


HEDIS Program Manager



Job Family

Quality Group


United States of America

FLSA Status

United States of America (Exempt)

Recruiting Start Date


Date Requisition Created


Work Experience

Network, Project/Program Management


Bachelors (Required), Masters: Health Administration, Masters: Nursing

License and Certifications - Required

License and Certifications - Preferred

Other Job Requirements


Required Qualifications

  • Working knowledge of HEDIS.
  • Development and/or implementation of interventions and programs to support HEDIS quality improvement.
  • Experience working in a managed care health plan and experience working in a Medicaid managed health plan.
  • Demonstrated project management skills.
  • Strong written and verbal communication skills.
  • Ability to work effectively in a virtual work environment.
  • Ability to multi-task and work in a matrixed work environment.

Preferred Qualifications

  • Experience with NCQA accreditation standards and processes
  • Behavioral health experience

Magellan Health Services is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled. Every employee must understand, comply and attest to the security responsibilities and security controls unique to their position.

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