Manager HEDIS Quality

Irving, Texas, Description Summary: Responsible for creating and facilitation training strategies/programs to support an operational team responsible for abstraction and pursuit of HEDIS® measures to ensure they reach operational milestones, gap closures, rates, and overall successful quality standards. Manages, coordinates, and facilitates HEDIS® training, including 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 plans. Assures that all QI activities are relevant to the needs of targeted population. Work collaboratively with vendors, internal/external, 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. Develop roadmap or response. Work with Network to ensure provider scrub list is pulled, worked and updated. Assist with CAHPS and STAR measures with quality metric reporting and analytics.

Oversees the implementation of new initiatives. Support PHQ-9 questions and coordination care, when needed. Leads interactions with regulators or oversight entities. Oversees quality improvement activities for the largest, most complex health plan partners’ programs. Requirements: Bachelor’s degree in Health Administration, Nursing, or a related field required Expert knowledge with HEDIS technical specifications Expert knowledge with HEDIS value sets and coding Project management knowledge with deep understand if certification is not present 5+ years clinical experience preferred HEDIS Experience required, 4 or more years. Previous HEDIS measure training experience including HEDIS software workflow development Previous experience working with HEDIS chart retrieval, abstraction and over-reading Previous experience working with various HEDIS software programs RN or LVN/LPN License in the state of TX preferred  Work Type: Full Time

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