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.