Quality Program Manager, HEDIS Production, Health Plan

Albuquerque NM 87113

Job Description

Responsible for assisting with the HEDIS production quality program for the local health plan including strategic planning, program development and leadership, HEDIS vendor oversight, and staffing. He/she serves as a member of the management team whose role is designing, implementing, and monitoring the HEDIS production program to accurately measure the health plan on HEDIS measures. He/she will maximize medical record retrieval for Hybrid HEDIS measures and coordinate production of intervention-oriented forecasting reports that identify members in need of service gap closures.

● Develops the health plan’s HEDIS project plan to support accurate HEDIS and customer-mandated HEDIS-like measurement and reporting related to annual NCQA HEDIS data submission and reporting for member and provider interventions 
● Oversees all vendors that support health plan HEDIS and customer-mandated HEDIS-like measurement and reporting: (1) HEDIS Auditor, (2) HEDIS Technology, (3) Medical Record Retrieval and Abstraction, and (4) CAHPS. 
● Coordinates all vendors mentioned above at the health plan and works with the national director of quality for HEDIS production to ensure that vendor contracts fulfill pertinent NCQA and health plan requirements 
● Tracks vendor invoicing against health plan budget allocations 
● Works with health plan executive leadership to ensure vendor alignment with health plan goals and budgets 
● Analyzes HEDIS and HEDIS-like data to ensure measurement accuracy and to identify improvement opportunities at the health plan 
● Implements annual HEDIS production activities including HEDIS roadmap preparation and submission, audits, medical record retrieval and abstraction, CAHPS surveys, and customer-mandated HEDIS-like measure production and reporting 
● Implements initiatives to ensure programs accomplish objectives in a timely and successful manner 
● Directs and supervises quality staff at the health plan to meet HEDIS production goals, including opportunity identification, program design, and impact analysis and program evaluation 
● Oversees annual HEDIS production project plan at the health plan and ensure that it addresses all necessary aspects, vendors, stakeholders, deliverables, and due dates 
● Annually evaluates health plan’s HEDIS production project plan to identify opportunities for improvement based on lessons learned during the prior year 
● Coordinates all HEDIS production stakeholders, subject matter experts, process owners, and quality staff at the health plan to ensure deliverables are met on time and at high quality 
● Oversees HEDIS and HEDIS-like reporting at the health plan 
● Delivers timely reporting to business partners on pre-determined schedule 
● Provides consultation to business partners regarding HEDIS 
● Drive the health plan’s quality initiatives related to HEDIS and HEDIS-like measures 
● Manages health plan team:  hiring and training, performance and salary reviews, promotions and disciplinary matters for direct reporting employees 

General Job Information

Title

Quality Program Manager, HEDIS Production, Health Plan

Grade

26

Job Family

Quality Group

Country

United States of America

FLSA Status

United States of America (Exempt)

Recruiting Start Date

2/12/2020

Date Requisition Created

2/5/2020

Work Experience

Health Plans, Quality

Education

Bachelors: Healthcare (Required)

License and Certifications - Required

License and Certifications - Preferred

Other Job Requirements

Responsibilities

  • 5+ years of healthcare quality improvement experience. HEDIS experience.
  • Knowledge of quality improvement processes and performance measurement.
  • Demonstrated skills in project management.
  • Strong interpersonal and organizational skills.
  • Expertise in word processing and data management software.
  • Managed behavioral health and accreditation processes.
  • Knowledge of accreditation standards related to the book of business.

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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