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Manager of Quality Improvement & HEDIS

Little Rock, AR · Healthcare
Manager of Quality Improvement & HEDIS – Health Plan
Little Rock, AR
Manager of Quality & HEDIS Job Summary:
  • Oversee and manage the functions of the Quality Improvement (QI) program, including HEDIS reporting and other quality improvement activities.
  • Provide support to staff and communicate with departments to facilitate daily QI functions
  • Review and analyze reports, records and directives.
  • Confer with staff to obtain data such as new projects, status of work in progress, and problems encountered, required for planning work function activities, including HEDIS reporting.
  • Verify data to be submitted in accordance with government program requirements and ensure compliance with state, federal and certification requirements.
  • Prepare reports and records on work function activities for management.
  • Oversee the review and analysis of reports.
  • Evaluate current procedures and practices for accomplishing the assigned work functions objectives to develop and implement improved procedures and practices and to ensure compliance with required standards.
  • Manage delegate vendor oversight and corrective action plans as indicated.
  • Monitor and analyze costs and participate in the preparation of the budget.
Manager of Quality & HEDIS Background:
  • Requires Bachelor of Science in Nursing, healthcare, business, or related field; Master’s degree a plus.
  • Certified Professional in Healthcare Quality (CPHQ) is highly preferred.
  • Minimum of 4-5 years Quality Improvement/HEDIS experience
  • Requires IN-DEPTH knowledge of HEDIS gaps, HEDIS Compliance and Star Ratings, and NCQA 
  • Around 1-2 year of progressive staff supervision or program managent/lead experience within a healthcare environment.
  • Extensive knowledge of Medicare, Medicaid and similar state health programs, their regulatory guidelines, benefit management and coverage determination, reconsideration, and appeal processes.
  • Requires direct working experience with Quality Improvement Initiatives such as: STARS, HEDIS, and/or CAHPS
  • Possess planning, organizing, conflict resolution, negotiating and interpersonal skills.
  • Experience in training, teaching, and coaching staffs to meet operational requirements and goals.
  • Strong oral and written communication skills; ability to interact with all levels of internal and external contacts.
  • Must be able to prioritize, plan, and handle multiple tasks/demands simultaneously. 

480.269.9491 (CALL – TEXT – FAX)
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