Director, Predictive Modeling and Customer Experience Analytics

CareSource • Dayton, OH

1d • Onsite

About The Position

The Director, Enterprise HEDIS Operations and Data Integration leads and provides strategic guidance for HEDIS reporting projects for all markets and products with year-round monitoring and annual required reporting, and oversees data integration and expansion strategies (HIE, Provider data and Supplemental data). This role involves leading HEDIS Operations and HIE Teams, directing activities, hiring, training, coaching, counseling, and evaluating performance of direct reports. The Director will develop annual HEDIS project plans, lead project progress, and ensure deadlines are met, while also supporting market-specific required quality metric reporting and ensuring compliance with HEDIS specifications, policies, operating procedures, and goals. Key responsibilities include leading HEDIS and clinical data related audits, managing onsite reviews, and preparing audit documentation. The role also involves expanding innovation in clinical data collection, identifying data anomalies, closing data collection gaps, and leading vendor meetings to extend CareSource's data reach. The Director will identify and implement opportunities to improve data collection efficiency, oversee monitoring of supplemental and EHR/HIE databases, and lead HEDIS data processing efforts. Collaboration with IT partners for HEDIS processing, data quality oversight, and troubleshooting is crucial. Additionally, the position involves strategizing potential data integration opportunities, leading vendor management for RFP and business case buildout, and managing relationships with external vendors for HIE and HEDIS.

Requirements

• Bachelor's degree or equivalent years of relevant work experience is required
• Minimum of seven (7) years of experience working in managed care (multiple states/markets and line of businesses experience is required), health care delivery systems, in a public agency serving a related population, or equivalent experience in quality/process/ project management is required
• Minimum of five (5) years of supervisory experience including hiring, training, assigning work and managing the performance of staff or as a lead in a functional area, managing teams on large scale projects is required
• Minimum of five (5) years HEDIS experience required
• Exceptional analytical, problem solving and critical thinking skills
• Demonstrated ability in identifying problems, developing solutions and implementing effective courses of action
• Strong communication skills required, including the abilities to effectively communicate succinctly and to a senior level audience verbally and in writing, internally and externally, and at different levels as necessary
• Build ROI analysis, manage department budget, and provide recommendations to senior leadership to improve data management and analytics related to HEDIS
• Demonstrated ability to work effectively and productively with varied levels of personnel, with professionals and business organizations
• Strong service orientation and consulting skills
• Strong leadership development skills to promote upward and lateral mobility for team
• Ability to lead mission-critical, high visibility projects
• Proven ability to juggle multiple complex priorities within a changing environment
• Knowledge of software development, systems and application lifecycles
• Proficiency in MS Office and Project Management tools

Nice To Haves

• Project management experience preferred

Responsibilities

• Leads HEDIS Operations and HIE Teams – directs activities, hires, trains, coaches, counsels, and evaluates performance of direct reports
• Develop annual HEDIS project plan; lead project progress and timeliness to ensure deadlines are met
• Support market-specific required quality metric reporting where applicable
• Ensure compliance with HEDIS specifications, policies, operating procedures, and goals in compliance with internal and external guidelines
• Directly responsible for leading all HEDIS and clinical data related audits, leading onsite reviews and the collection and preparation of audit documentation
• Submit thorough documentation and response to auditor requested data or process investigations, summarizes findings and presents to senior leadership team
• Provides strategic support to markets as Subject Matter Expert of HEDIS and other performance measure Technical Specifications
• Expand innovation in clinical data collection, identify data anomalies and close data collection gaps to increase performance outcomes
• Lead vendor meetings and onboard new vendors to extend CareSource data reach
• Identify and implement opportunities to improve rates or efficiency of data collection - i.e., alternative sources for administrative or supplemental data, lead meetings with market and enterprise leaders to align with quality improvement goals
• Oversee monitoring and outcomes of supplemental and EHR/HIE databases
• Lead HEDIS data processing efforts for all markets and products for HEDIS engine
• Collaborate with IT partners to execute HEDIS processing and troubleshoot if issues are identified
• Provide oversight and lead meetings in association with IT for incoming data sources and ensure data quality and integrity and troubleshoot if issues are identified
• Identify and strategize potential data integration opportunities to optimize data intake for Quality measures
• Lead efforts with Vendor management for RFP and business case buildout
• Lead HEDIS operations and data collection strategy to optimize performance measurement
• Manage relationships and lead conversations with external vendors for HIE and HEDIS
• Perform any other job duties as requested

Benefits

• Substantial and comprehensive total rewards package
• May qualify for a bonus tied to company and individual performance

What This Job Offers

• Job Type: Full-time
• Career Level: Director
• Number of Employees: 11-50 employees