Manager Health Plans Quality - Health Plan Admin

Summary:

Responsible for creating and facilitation training strategies/programs to support an operational team responsible for working closely with and understanding the process of abstraction and pursuit of HEDIS® measures to ensure that operational milestones, gap closures, rates, and overall successful quality standards are met. Equally responsible for all program descriptions, evaluations and workplans being created and managed year over year.

Responsibilities:

• Must be able to create dashboards, use SPSS, Qualtrics or similar software programs to create appropriate analysis of monthly output/input
• Work with Patient Safety to produce adhoc reports; must be a true team player and willing to go the extra mile
• Handle all program descriptions, evaluations workplans and CAHPs reporting. (i.e. PD/PE & CQMP &CQMP AR).
• Assist HEDIS team to facilitate and coordinate HEDIS® training, technical training understanding, and workflow processes,
• Be knowledgeable of HEDIS® software training, admin and hybrid measure training and creating training materials
• Coordinates training related to external client facing program; develops program success measures and performs periodic assessments of program success.
• Assures compliance with corporate QI work plan.
• Must be a good writer, communicator and possess the skills to get along with others.
• Assures that all QI activities are relevant to the needs of targeted population.
• Work collaboratively with various departments, vendors, internal/external, when necessary to leverage our resources effectively
• Maintains effective documentation of research programs to meet regulatory and Accreditation Standards.
• Provides oversight to assure accurate and complete quantitative analysis of clinical data and presentation of data analysis results.
• Participates in and provides input to the development of new product designs for major line of business.
• Oversees the implementation of new initiatives.
• Leads interactions with regulators or oversight entities.
• Oversees quality improvement activities for the largest, most complex health plan partners’ programs.

Requirements:

• Bachelor’s in health administration, Informatic nursing, nursing or a related clinical field required in lieu of RN licensure
• Masters in public policy – Administration, Nursing informatics, MBA, MPH or MPA preferred
• 4 years of health care quality or data analysis experience.
• 5-7 years of HEDIS experience, or any combination of education and experience, which would provide an equivalent background that shows proficiency.
• Project management knowledge with deep understanding if certification is not present preferred
• Program management with at least 2 plus years of experience preferred
• RN Licensure required in lieu of Bachelor’s degree

Work Type:

Full Time

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