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Manager-HEDIS Program (Remote, North Carolina Based)

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The Manager of the HEDIS Program educates and serves as HEDIS SME for Quality Management (QM) teams, leadership inside IT, Care Management (CM), Provider Network(PN), and other related business areas, coordinates and monitors quality improvement and organizational projects from inception to closure including National Committee for Quality Assurance (NCQA) and Healthcare Effectiveness Data and Information Set (HEDIS) preparation in order to identify opportunities for improvement, monitor the success of quality improvement initiatives, track improvement, and provide a set of measurement standards.

This position is full-time remote. Selected candidate must reside in North Carolina. Some travel for onsite meetings to the Home office may be required.

Responsibilities & Duties

Staff Management and Development

Work with Human Resources to attract, develop, and retain highly qualified employees when direct report clinical analysts are needed to be added to the HEDIS program to support all Alliance organizational and related business areas
Ensure staff are well trained in and comply with all organization and department policies, procedures, and business processes
Organize workflows and ensure staff understand their roles and responsibilities
Ensure current QM the team has the needed tools and resources to achieve goals, support employees, and ensure compliance with licensure, regulatory, and accreditation requirements related to a successful HEDIS Program
Actively establish and promote a positive, diverse, and inclusive working environment that builds trust
Ensure all staff are treated with respect and dignity
Ensure standards are transparent and applied consistently, impartially, and ethically over time and across all staff members
Work to resolve conflicts and disputes, ensuring that all participants are given a voice
Set goals for performance and deadlines in line with organization goals and vision
Effectively communicate feedback and provide ongoing coaching and mentoring to staff and support a learning environment to advance team skills and professional development
Cultivate and encourage efforts to expand cross-team collaboration and partnership
Manage HEDIS projects

Develop and maintain a detailed HEDIS project plan to include milestones, tasks, and target/actual dates of completion
Coordinate Work Plan, team and resources for HEDIS Consumer Assessment of Healthcare Providers and Systems (CAHPS) submission to Connector Authority and NCQA
Monitor the creation of all project deliverables to ensure adherence to standards including design documents, test plans and operations documentation
Support the project life cycle including requirements gathering, creation of project plans and schedules, manage resources, support HEDIS audit process, and facilitate project execution, deployment and closure
Maintain detailed project documentation including meeting minutes, action items, issues lists and risk management plans to be shared with Data Manager, NCQA Manager, QM Director, SVP and CMO
Coordinate data analysis and quality intervention and report on findings

Provide recommendations for systems and technical requirements to assist with accurate HEDIS data retrieval and submission to NCQA during reporting years
Collaborate and Coordinate with teams on all data pulls and ongoing data management for HEDIS and QI project management databases for identified QI projects with department staff and external contacts
Ensure the unique requirements for HEDIS data collection are met
Evaluate HEDIS performance data to identify opportunities for improvement, monitor the success of quality improvement initiatives, track improvement, and provide a set of measurement standards that allow comparison with other plans.
Evaluate data to identify performance gaps and establishment of realistic targets for improvement
Design, run, and manage the data review process to ensure accuracy and integrity of data reports to meet regulatory and operational requirements
Evaluate sources for alternative data capture
Assess ongoing methodology and results
Coordinate and implement interventions to increase HEDIS, CAHPS and designated health measures for the Plan
Analyze data and develop presentations and materials for committees and leadership
Assess prior year’s data collection and reporting activities, identify opportunities for improvement in the efficiency and effectiveness of the activities, and recommend process improvements
Collaborate with and provide functional knowledge to internal staff and Stakeholders

Help manage internal and external communication strategies around HEDIS measures
Adhere to NCQA standards and collaborate with Accreditation team in maintaining NCQA accreditation
Provide functional and technical knowledge for NCQA HEDIS and deliver educational sessions to internal staff and external constituents as needed
Be a resident HEDIS expert by providing clear and concise updates to measure changes, answering internal questions on measure definitions, and coaching and training teams on HEDIS needs
Support the coordination of corporate compliance and external surveys as needed
Minimum Requirements

Education & Experience


Bachelor’s degree in healthcare or business and at least five (5) years of experience in healthcare setting, including clinical experience and experience with quality data analysis, HEDIS measures, and reporting working with related stakeholders; providers or health plan provider teams, Risk Management, finance, Stars teams and Care Coordination/Management


Master’s preferred- PM, MN- Informatics, MBA, MPH, or MPA. Current and active Registered Nurse (RN) license or Clinical BH license (LCSW, LCMHC, LMFT)

Knowledge, Skills, & Abilities

Knowledge of NCQA Health Plan HEDIS data collection and reporting requirements and processes
Understanding of the operational requirements for data collection in support of HEDIS or similar Quality programs
Knowledge of Project Management principles
Knowledge of Quality Improvement principles
Microsoft applications including PowerPoint, Excel
Problem solving skills
Clear, concise, and direct communication, training, and presentation skills
Ability to use data to make decisions
Ability to manage large projects with multiple elements and expectations.
Ability to independently identify inefficiencies and then find ways to improve, streamline, or reinvent workflows
Salary Range

$68,359- $117,679/Annually

Exact compensation will be determined based on the candidate’s education, experience, external market data and consideration of internal equity.

An excellent fringe benefit package accompanies the salary, which includes:

Medical, Dental, Vision, Life, Long Term Disability
Generous retirement savings plan
Flexible work schedules including hybrid/remote options
Paid time off including vacation, sick leave, holiday, management leave
Dress flexibility