HEDIS Program Consultant III

Medica•Minnetonka, MN

1d•Hybrid

About The Position

Medica is a nonprofit health plan serving over a million members across multiple states, focusing on personalized healthcare and provider partnerships. The HEDIS Program Consultant III is a senior-level role within the HEDIS Audit and Submissions team, responsible for project management and subject matter expertise in HEDIS measure production. HEDIS measures are crucial for improving member health, meeting regulatory and accreditation standards, and supporting Medica’s strategic programs. This role involves leading cross-functional projects, managing project plans, and proactively addressing challenges to ensure initiatives stay on track. The individual will act as a resource to others, leveraging a strong understanding of HEDIS lifecycle operations and audit processes.

Requirements

Bachelor's degree or equivalent experience in related field
5+ years of related work experience in Project Management
Eligibility to work in the US: Medica does not offer work visa sponsorship for this role. All candidates must be legally authorized to work in the United States at the time of application. Employment is contingent on verification of identity and eligibility to work in the United States.

Nice To Haves

Project management experience with HEDIS audit and submissions with demonstrated success facilitating/leading complex projects with drive and initiative.
Knowledge of health care regulatory entities and related reporting requirements.
Experience working with multidisciplinary teams, navigating a large organization, and professionally interacting with external vendors and provider organizations.
Demonstrated experience documenting processes, utilizing web-based applications, and making recommendations on new procedures/projects to influence the team and goals.
Ability to manage multiple projects and priorities; comply with tight deadlines.
Ability to manage relationships and work collaboratively to achieve solutions and goals.
Ability to adapt to ever-changing quality measurement application tools.
Strong knowledge of the health care industry including but not limited to HEDIS production, health care products, payment systems, operations, policies and procedures.
Ability to explain health care quality measures and related processes in layman’s terms.
Strong written and verbal communication skills and listening skills.
Creative problem solving and critical thinking abilities.

Responsibilities

Assist in planning and managing multiple projects related to HEDIS/QRS measures to ensure accurate and valid data.
Lead and participate in planning efforts to identify opportunities that support Medica’s priorities and meet customer requirements.
Build and maintain strong relationships with vendors, regulatory agencies, and internal and external stakeholders.
Serve as a key point of contact for the HEDIS software vendor, HEDIS auditor, and for submission of quality measurement data to accreditation, federal, and state regulatory bodies.
Support the annual submission of HEDIS and QRS reporting, including the compliance audit.
Coordinate with the Clinical Quality Review team and external vendors on chart review sampling and chart chase logic.
Stay current on regulatory requirements and contribute to ongoing improvements in HEDIS and QRS data collection processes.
Document and maintain team processes and project plans to track progress and ensure timelines are met.
Support reporting processes that incorporate results from certified HEDIS® software vendors, NCQA, CMS, state agencies, and other relevant sources.
Collaborate across the organization with teams including Quality, Analytics, Network Management, Claims Operations, Information Technology, and Market Business Segments to monitor key quality metrics and support organizational priorities.
Performs other duties as assigned.