Manager, HEDIS Clinical Quality Data & Technology

General Summary

Provides direction and guidance to program and project managers to assist with all aspects of clinical quality data/reports, technology, daily operations and various initiatives that support iCare's HEDIS program. Partners with business leaders at all levels to envision, define and initiate programs and monitor cost while working to ensure the ultimate success of the program.

Essential Functions

Provide direct supervisor to the HEDIS Operations team. Hire, train, complete payroll, disciplinary action/corrective action of all direct reports

Collaborate with executive leadership for HEDIS operations to ensure PCP offices have successful on-site tele-retinal diabetic

screenings, and member outreach efforts

Promote HEDIS expansion efforts by onboarding and initiating new office partnerships with Independent Physician Association (IPAs) and Wholly Owned locations of Management Services Organization (MSOs)

Perform initial training and ongoing support for the Operations team

Manage and validate non-compliant patient lists sent from health plan partners as well as PCP offices to include accuracy, distribution to team, monthly updates, and meet ongoing needs

Collaborate with coordinator team members and upper management for any grievances or issues that arise. Report accordingly per compliance policy

Capture and analyze data to drive informed KPI outcomes for the team

Work with staff on identifying process improvements

Validate member eligibility for services using designated platforms

Manage Health Plan and Partner Reporting needs including quarterly disbursement of PCP Satisfaction Surveys and collectively gather results and analyze trends, process improvements, and efficiencies

Strategize scheduling efforts based on geographic locations and PCP partnerships

Format, update, and delivery of all MSO bi-weekly/monthly reports

Job Specifications

Typically has the following skills or abilities:

Bachelor's Degree in Business Administration or related field, or equivalent experience

Minimum of 3 years of management experience with responsibilities for hiring, training, assigning work, and managing the performance of direct reports

Experience with HEDIS project management/program management, leading large and complex projects

Familiarity with various project management methodologies, standard concepts, practices, procedures, tools, and/or software packages within a structure PMO environment

Experience working with health care plans, MSOs, and HEDIS programs

Extensive enterprise-level experience and judgment to plan and accomplish goals

Proven ability to navigate complex situations through organizational landscape and with multiple stakeholders

Strong leadership skills to coordinate and motivate program and project teams

Adept at financial management to administer budgets across multiple projects and ensure the program meets its requirements for return on investment, timing, and budget

Ability to drive results through informal authority, serve as a consultant to key business partners, and represent users and customers in every thought and interaction

Proven ability to successfully manage risks/issues across multiple programs

Ability to elicit cooperation from Executive & Senior Management and other departments

Skilled decision-maker showing balanced consideration of business issues

Excellent written and verbal communication skills and analytical skills

Strong business aptitude and problem-solving skills

Strategic thinker to support envisioning work, program planning, and forecasting

Willing to travel as required (estimate 10%)