HEDIS Project Manager ÔÇô Health Plan Quality
Summary
| Title: | HEDIS Project Manager ÔÇô Health Plan Quality |
|---|---|
| ID: | HP001 |
| Location: | Rochester or Buffalo |
| Job Type: | Full-time |
| Date Posted: | 11/02/2016 |
| Openings: | 1 |
| Department: | Health Plan Quality |
Description
GRADE: 307
POSITION SUMMARY
The role’s primary function is to manage the HEDIS/QARR program for the Managed Medicaid, Child Health Plus, Option Plus and Essential plan lines of business in addition to any new lines of business that may be added. This includes development, training and management of the HEDIS teams. Responsible for managing timelines associated with the program, work plans, coordination of data with IT analyst, development of chase strategy & medical record review, prepare audits, develop working relationships with internal healthplan teams, HEDIS vendor, NCQA & NYS DOH Auditors, submissions to NCQA, auditor, and DOH. This position will work closely with the Quality Team and develop year round strategies to improve quality measure rates and ultimately improve our member health outcomes.
POSITION HAS DIRECT REPORTS No
ESSENTIAL JOB DUTIES/FUNCTIONS
OTHER FUNCTIONS AND RESPONSIBILITIES
- Participate in meetings applicable to designated work activities
- Performs other duties as assigned
MINIMUM REQUIREMENTS/LICENSES/CERTIFICATIONS
- Knowledge of Quality Management Programs
- Knowledge of NCQA accreditation and certification
POSITION SUMMARY
The role’s primary function is to manage the HEDIS/QARR program for the Managed Medicaid, Child Health Plus, Option Plus and Essential plan lines of business in addition to any new lines of business that may be added. This includes development, training and management of the HEDIS teams. Responsible for managing timelines associated with the program, work plans, coordination of data with IT analyst, development of chase strategy & medical record review, prepare audits, develop working relationships with internal healthplan teams, HEDIS vendor, NCQA & NYS DOH Auditors, submissions to NCQA, auditor, and DOH. This position will work closely with the Quality Team and develop year round strategies to improve quality measure rates and ultimately improve our member health outcomes.
POSITION HAS DIRECT REPORTS No
ESSENTIAL JOB DUTIES/FUNCTIONS
|
% of Time
|
Essential Function |
90%
|
Year Round Management of HEDIS/QARR - Participates in the design, development, implementation, monitoring and revision of activities related to the HEDIS / QARR Management Program to ensure compliance to state, federal regulations and accreditation standards, in addition to improving the quality of care and services rendered to members. - Prepares submissions for IDSS and DSS tools - Provides input into the Health Plan quality work plan activities and annual quality program evaluation - Provides education, assistance and coaching to staff involved in HEDIS activities and best practices quality improvement methods, measurement, analysis and performance tracking. |
|
10%
|
Participates in Quality Management Activities - Provides input into the Health Plan quality work plan activities and annual quality program evaluation - Ensure regulatory requirements including NCQA, IPRO and the NYS DOH are met - Work with Informatics Team to mentor team, assist with documentation and measurement of program outcomes. |
| |
|
|
|
OTHER FUNCTIONS AND RESPONSIBILITIES
- Participate in meetings applicable to designated work activities
- Performs other duties as assigned
MINIMUM REQUIREMENTS/LICENSES/CERTIFICATIONS
- Current unrestricted NYS RN license
- Minimum of 5 years’+ experience with managing HEDIS Program
- Advanced degree in a health, behavioral science, public health, or related field
- Strong written and communication skills with the ability to write clear, structured, articulate, and persuasive proposal responses
- Strong editing skills with attention to detail and ability to meet deadlines
- Experience working in deadline-driven environments
- Able to work well in a team environment, handle multiple tasks, and meet deadlines
- High level initiative, problem solving, and collaboration abilities
- Able to effectively coordinate efforts across different organizational departments and also with external organizations
- Able to monitor and meet program goals
- Proficient in use of Microsoft Office Suite and use of the Internet
PREFERRED QUALIFICATIONS
- Minimum of 5 years’+ experience with managing HEDIS Program
- Advanced degree in a health, behavioral science, public health, or related field
- Strong written and communication skills with the ability to write clear, structured, articulate, and persuasive proposal responses
- Strong editing skills with attention to detail and ability to meet deadlines
- Experience working in deadline-driven environments
- Able to work well in a team environment, handle multiple tasks, and meet deadlines
- High level initiative, problem solving, and collaboration abilities
- Able to effectively coordinate efforts across different organizational departments and also with external organizations
- Able to monitor and meet program goals
- Proficient in use of Microsoft Office Suite and use of the Internet
- Knowledge of Quality Management Programs
- Knowledge of NCQA accreditation and certification
This opening is closed and is no longer accepting applications
