Manager Health Plans Quality - US Family Health Plan

CHRISTUS Health•Irving, TX

About The Position

Responsible for creating and facilitating training strategies and programs for an operational team that works closely with and understands HEDIS® measure abstraction and pursuit processes. The role ensures operational milestones, gap closures, rates, and overall quality standards are achieved. It is also responsible for creating and managing program descriptions, evaluations, and workplans year over year. The manager oversees quality improvement activities for programs involving the largest and most complex health plan partners, ensures compliance with corporate quality improvement work plans, and confirms that quality activities address the needs of the targeted population. The role provides oversight of quantitative clinical-data analysis and presentation of findings, maintains research-program documentation to meet regulatory and accreditation standards, and leads interactions with regulators or oversight entities. It also collaborates across departments and with internal and external vendors, supports new product designs, and oversees implementation of new initiatives.

Requirements

Bachelor’s degree in health administration, informatic nursing, nursing, or a related clinical field, unless RN licensure is held in lieu of the degree.
RN licensure is required in lieu of a bachelor’s degree.
Four years of healthcare quality or data analysis experience.
Five to seven years of HEDIS experience, or an equivalent combination of education and experience demonstrating proficiency.
Good writing and communication skills, and the ability to work well with others.

Nice To Haves

Master’s degree in public policy/administration, nursing informatics, business administration, public health, or public administration.
Project management knowledge and a deep understanding of project management if certification is not present.
At least two years of program management experience.

Responsibilities

Create dashboards and use SPSS, Qualtrics, or similar software to analyze monthly output and input.
Work with Patient Safety to produce ad hoc reports.
Handle program descriptions, evaluations, workplans, and CAHPs reporting, including PD/PE, CQMP, and CQMP AR.
Assist the HEDIS team with coordinating and facilitating HEDIS® training, technical training, and understanding of workflow processes.
Provide or coordinate HEDIS® software, administrative, and hybrid-measure training, and create training materials.
Coordinate training for external client-facing programs, develop program success measures, and periodically assess program success.
Ensure compliance with the corporate quality improvement work plan and that quality improvement activities are relevant to the needs of the targeted population.
Collaborate with departments and internal and external vendors to leverage resources effectively.
Maintain documentation of research programs to meet regulatory and accreditation standards.
Oversee accurate and complete quantitative analysis of clinical data and presentation of analysis results.
Participate in and provide input to new product designs for major lines of business.
Oversee implementation of new initiatives.
Lead interactions with regulators or oversight entities.
Oversee quality improvement activities for programs involving the largest and most complex health plan partners.
Work collaboratively as a team member and communicate effectively with others.