HEDIS Project Manager - Managed Care
*** This is a Full Time, Direct Hire / Permanent opportunity! ***
Your Job Summary:
The HEDIS Project Manager is an integral part of the team serving as the clinical subject matter expert and primary contact to internal and external stakeholders in all matters related to collection and analysis of HEDIS and CAHPS data. The HEDIS Project Manager is responsible for providing leadership and direction to ensure the annual HEDIS submissions are delivered according to technical specifications and deadlines. HEDIS duties include roadmap preparation, oversight of medical record review done by chart reviewers, data accuracy and reporting, and interacting with HEDIS auditors for regulatory compliance according to regulations. Responsible for HEDIS project management in collaboration with other key departments and external vendors and auditors.
- Bachelor of Science in Nursing, Business or Healthcare Administration, Analytics, or related field is required.
- Around 3-5 combined years of prior recent HEDIS experience, including roles such as data collection, over-reading, project management, etc.
- Roughly 1-3 years of Project Management experience, preferably related to HEDIS, Quality Improvement or other accreditation surveys.
- At least 2-3 years’ experience in a Managed Care Organization (Health Plan/HMO/MSO/TPA/IPA/etc).
- Ability to manage multiple, complex projects with strict HEDIS deadlines.
- Strong knowledge of health care related coding and/or STAR ratings is a plus.
- Thorough understanding of statistics, data analytics, modeling, reporting methods and data mining methodologies.
- Resourcefulness as demonstrated by the effective application of professional knowledge to new situations. Possess planning, organizing, conflict resolution, negotiating and interpersonal skills.
- Experience in training / teaching staffs to meet operational requirements and goals.
- Strong oral and written communication skills; ability to interact with all levels of internal and external contacts.
- Strong analytical mind, with problem solving and investigative skills, an aptitude for accuracy, and attention to detail.
- Must be computer literate and knowledgeable in MS Office, E-mail and EMR systems, and multiple additional programs including word processing, and data management.
- Possess superior verbal and written communication skills, able to interface with business and medical professionals.
- Leads planning, analysis, development, reporting and submission of HEDIS and other mandatory reports to regulators or accreditors.
- Provides project leadership to develop annual HEDIS project plan, and monitor progress and timeliness.
- Coordinate completion of HEDIS roadmap in conjunction with related initiatives and mandates.
- Ensure compliance with HEDIS technical specifications, policies, operating procedures, and goals in compliance with internal and external guidelines.
- Monitor project progress and timeliness to ensure deadlines are met.
- Provide timely HEDIS measure status reporting, including trending and analyzing of the data.
- Define objectives, processing requirements and specifications to document steps taken and results achieved related to HEDIS results
- Able to conduct data extraction from source systems for validation and analysis.
- Manages and validates HEDIS data, assures data integrity and reporting.
- Acts in the role of clinical subject matter expert for all matters related to HEDIS requirements.
- Serve as a primary HEDIS contact for client inquiries and sales process.
- Develop training manual annually and other educational materials.
- Effectively oversees external vendor performance related to medical record data collections.
- Accurately assess data, identify opportunities and facilitate cross-departmental prioritization of rate improvement quality work.
- Collaborate with departments to design, implement and monitor effectiveness of interventions.
- Provide comprehensive analysis of HEDIS measures, barriers, and opportunities and present results of improvement efforts and ongoing performance measures to senior management.
- Creates and makes formal presentations of trending reports throughout HEDIS cycle to keep executive management apprised of current status.
- Participate in the HEDIS post mortem analysis to increase rates and evaluate and analyze annual HEDIS rates.
- Develop and respond to HEDIS Audit Corrective Action Plan (CAP) as necessary; and develop work plan for tracking of the HEDIS Quality Improvement Intervention Measures.
- Development and execution of HEDIS intervention steps to improve targeted measures.
- Assist in coordinating new enhancements, including system enhancements and report generation, to improve HEDIS scores.
- 20% local travel, occasional weekend and evening commitments