HEDIS Quality Manager- Texas Territory

UnitedHealth Group•Irving, TX

20d•$72,800 - $130,000

About The Position

The HEDIS Quality Manager drives consistent implementation of programs designed to achieve at least a 4-Star quality rating and improve HEDIS/Star results for contracted physicians. The role supports the financial viability of the market’s HEDIS/Star program and the quality of care provided to members. It calls for strategic planning and analysis, knowledge of HEDIS and coding, management and communication skills, and the ability to develop action plans and resolve complex issues with interdependencies. The position travels up to 25% across Texas to support business and provider needs. The manager leads Quality Coordinators and Clinical Quality Consultants (CQC I, II, and Senior), overseeing staff development, performance, education, and market quality operations. The role works across clinical, operational, regional, and corporate teams, while supporting physician partners and addressing provider questions, barriers, and escalated concerns. It also analyzes data, communicates provider needs and relevant industry and company information, and helps develop solutions that advance HEDIS/Star goals.

Requirements

At least 5 years of related experience in Quality, HEDIS/CMS Stars, ICD-10/CPT/CPT II coding knowledge, and Provider Relations.
At least 2 years of supervisory experience.
Solid working knowledge of Medicare quality operations, including HEDIS, Stars, coding, and Medicare Advantage.
Knowledge of state and federal laws relating to Medicare.
Advanced Microsoft Office skills and proficiency in Excel.
Ability and willingness to travel locally and non-locally as determined by business needs, including up to 25% travel.
Exceptional analytical and data representation expertise.
Valid driver’s license, reliable transportation, and current automobile insurance.
Ability to lift up to 10 pounds.
Ability to sit and stand for extended periods.
Ability to use fine motor skills to operate office equipment and/or machinery.
Ability to receive and comprehend instructions verbally and/or in writing.
Ability to use logical reasoning for simple and complex problem solving.

Nice To Haves

Solid knowledge of clinical standards of care, preventative health, and STAR measures.
Project management experience.
Solid financial analytical background within Medicare Advantage plans, including Risk Adjustment/STAR calculation models.

Responsibilities

Manage Quality Coordinators and Clinical Quality Consultants (CQC I, II, and Senior) and oversee market HEDIS/Star results for contracted physicians.
Hire, train, coach, and develop staff.
Set objectives and support staff performance and technical expertise through training, skill development, and leadership.
Delegate, monitor, and control work related to HEDIS/Star metrics, initiatives and action plans, staff productivity, and administrative expenses.
Participate in developing and implementing systems and processes that support quality operations.
Coordinate effectively with the Medical Director, Market Medical Director, Market Operations, Regional Team, Clinic Operations, and corporate departments.
Handle complex provider inquiries and problems, facilitate resolution, and maintain favorable provider relationships while protecting organizational interests.
Take ownership of work processes and provide information that helps physician partners meet initiatives.
Analyze data and collaborate with colleagues and business partners to identify potential root causes of issues.
Understand providers’ goals and strategies to support analysis and resolution of their issues.
Work with internal stakeholders to identify provider obstacles and barriers and methods to remove them.
Communicate and advocate providers’ needs to internal stakeholders to develop solutions that meet HEDIS/Star goals.
Communicate industry and company information to providers through newsletters, emails, outreach calls, teleconferences, conferences, and on-site meetings.
Develop and coach staff to facilitate strategic business meetings with physician groups and their staff.
Guide, oversee, and ensure the competency of market quality staff.
Assist corporate and local education teams and provide input on tools used to educate quality staff and local provider support staff.
Ensure education objectives are met through formal and ad-hoc education.
Ensure quality staff respond to market operations and provider inquiries.
Facilitate provider discussions and help negotiate resolution of escalated provider issues, determining when escalation is needed.
Work with cross-functional leadership to eliminate duplication of effort and member or provider abrasion.
Perform other related duties as assigned.