HEDIS Project Manager - Remote

UnitedHealth Group•Eden Prairie, MN

4d•Remote

About The Position

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together. We're seeking a HEDIS Project Manager who will oversee and coordinate year-round HEDIS production projects for our health plan clients. Activities include: (1) HEDIS Roadmap submissions to clients' HEDIS Auditors, (2) HEDIS measures rate benchmarking responses to clients' HEDIS Auditors, (2) acting as liaison to clients' HEDIS Auditors, (3) acting as liaison to clients' CAHPS/QHP/HOS survey vendors, (4) acting as liaison to clients' HEDIS Software vendors, (5) acting as liaison to clients' medical record retrieval and abstraction vendors, (6) leading weekly meetings with clients' stakeholders to coordinate efforts and share status, (7) annual HEDIS Rates validation and submission for each client's populations into NCQA's IDSS portal, (8) debriefing each client based on annual lessons learned, and (9) coordinating implementation of the production of HEDIS data and rates generation within HEDIS Software for health plan clients that are new to HEDIS. You'll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges. For all hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week. Primary Responsibilities: Project Management HEDIS thought leadership/strategy HEDIS Roadmap preparation Leadership in how to approach HEDIS Auditors HEDIS Technical Specification navigation and application HEDIS Value Set Directory navigation and application Leadership in meetings with health plan clients, agenda setting and notation Navigation skill in these portals: NCQA, IDSS, HEDIS Auditors, HEDIS Software, Medical Record Retrieval, Abstraction, CAHPS/QHP/HOS Survey Vendors Coordination skill across multiple clients' annual HEDIS projects with shared milestones, dependencies, and KPIs Maintenance of governance artifacts (Roadmaps, SOPs, process flows, RAID logs) and ensure documentation standards are met Skill at driving prioritization and resource alignment across competing initiatives; escalate risks with clear options Ability to organize and facilitate HEDIS engine migration and implementation activities-manage timelines, dependencies, and stakeholder communication so development teams can deliver Serve as liaison across IT, clinical, operations, vendors, and auditors; run status meetings and track decisions You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Requirements

7+ years of healthcare experience
5+ years of experience in HEDIS project management
5+ years of experience in HEDIS operations
Proven solid organizational and communication skills; ability to manage governance artifacts and facilitate cross-functional alignment
Proven knowledge of HEDIS engine platforms (e.g., Optum Quality Manager, Inovalon's QSI-XL or equivalent) and healthcare data flows (claims, EHR, lab, pharmacy)
Demonstrated understanding of HEDIS Technical Specifications, ECDS measures, and CAHPS/HOS coordination
Proven success working in a matrixed organization and managing multiple projects as one program

Nice To Haves

Certifications: CPHQ, PMP, Lean/Six Sigma
RN experience
Experience preparing auditor submissions (IDSS/PLD)
Familiarity with project management tools (e.g., Smartsheet, Jira, MS Project, etc.)
Experience as a consultant to health plan clients
Understanding of the end-to-end HEDIS year-round production program of health plans across populations (Commercial, Exchange, Medicare, Medicaid) including operational management and analytics coordination
Experience across payer/provider environments and delegated entities

Responsibilities

Project Management
HEDIS thought leadership/strategy
HEDIS Roadmap preparation
Leadership in how to approach HEDIS Auditors
HEDIS Technical Specification navigation and application
HEDIS Value Set Directory navigation and application
Leadership in meetings with health plan clients, agenda setting and notation
Navigation skill in these portals: NCQA, IDSS, HEDIS Auditors, HEDIS Software, Medical Record Retrieval, Abstraction, CAHPS/QHP/HOS Survey Vendors
Coordination skill across multiple clients' annual HEDIS projects with shared milestones, dependencies, and KPIs
Maintenance of governance artifacts (Roadmaps, SOPs, process flows, RAID logs) and ensure documentation standards are met
Skill at driving prioritization and resource alignment across competing initiatives; escalate risks with clear options
Ability to organize and facilitate HEDIS engine migration and implementation activities-manage timelines, dependencies, and stakeholder communication so development teams can deliver
Serve as liaison across IT, clinical, operations, vendors, and auditors; run status meetings and track decisions