Manager HEDIS, Stars, & ACO Data Analytics #0714

Cinqcare • Washington, CT

1d • Hybrid

About The Position

Grace at Home is a provider-led, community-based health and care partner dedicated to improving the health and well-being of those who need care the most, with a deep commitment to high-needs, urban and rural communities. Our local physicians, nurses, and caregivers work together to serve people and the communities they live in, beyond just treating symptoms. We remove barriers by delivering personalized care as close to home as possible, often in-home, because we know a deep understanding of our patient’s race, culture, and environment is critical to delivering improved health outcomes. By empowering patients, providers, and caregivers with the support they need, we strive to make health and care a reality—not a burden—every single day. Join us in creating a better way to care. The Manager of HEDIS, Stars & ACO Data Analytics leads all aspects of HEDIS, Medicare Stars, and ACO quality measurement and reporting across product lines. This role ensures technical excellence, regulatory compliance, audit readiness, and timely submissions in accordance with the National Committee for Quality Assurance (NCQA), Centers for Medicare & Medicaid Services (CMS), and the Executive Office of Health and Human Services (EOHHS). The Manager drives quality performance improvement, optimizes pay-for-performance outcomes (e.g., Medicare Stars and Quality Withhold), oversees electronic clinical data integration, and works in a matrix environment with a multidisciplinary analytics team. This position significantly impacts regulatory standing, financial performance, and national quality ratings.

Requirements

• Bachelor’s degree in health, informatics, data science, or related field required
• Experience with Microsoft suite of tools (Excel, Word, PowerPoint, OneNote, Access etc.), PowerBI, and Tableau required
• 5+ years in healthcare analytics
• 5–10 years of HEDIS leadership experience
• Experience leading HEDIS audits
• Strong knowledge of HEDIS/QRS specifications, Medicare Stars measures, and healthcare data systems
• Proven team leadership and project management experience
• Strong analytical and communication skills
• Vendor management and process implementation experience

Nice To Haves

• Master’s degree (MBA, MPH, MS, or related) preferred
• SAS, SQL, and other statistical tools preferred

Responsibilities

• Establish and execute comprehensive operational work plans for HEDIS, Medicare Stars, and ACO quality performance.
• Lead the full HEDIS lifecycle: planning, data collection, validation, rate calculation, submission, and audit.
• Ensure compliance with NCQA, CMS, Medicaid, MMP (DSNP), and ACO requirements.
• Conduct performance analysis and root cause reviews to improve quality scores and financial incentives.
• Present results and performance insights to leadership and quality committees.
• Lead initiatives to expand and optimize electronic clinical data exchange with provider EHRs, laboratory systems, and the State immunization registry.
• Improve data integrity, reporting accuracy, and operational efficiency.
• Identify and resolve data integrity issues in partnership with data governance and analytics teams.
• Partner with internal teams and external stakeholders to enhance data systems and quality outcomes.
• Manage HEDIS software vendors and work with NCQA-certified auditors(s).
• Lead RFPs, contract oversight, and audit coordination.
• Monitor specification updates and ensure submission compliance.
• Lead, mentor, and develop cross-functional analytic and clinical staff.
• Ensure training, cross-training, and timely completion of all deliverables.
• Manage performance, accountability, and cross-functional team development.
• Partner with Operations, Clinical, Network, Finance, Analytics, Practice Transformation, Care Management, Pharmacy, and Social Care.
• Support state and federal reporting requirements.
• Contribute to budgeting and strategic planning for quality analytics.
• Adhere to corporate compliance standards and regulatory requirements.

Benefits

• Competitive Compensation
• 401(k) with Employer Match
• Comprehensive Medical Plan
• Dental & Vision Coverage
• Employer-Paid Insurance: Life, Short-Term Disability (STD), and Long-Term Disability (LTD)
• Generous Paid Time Off
• Continuing Medical Education (CME) Allowance for APPs
• Commuter Benefits
• Mileage Reimbursement

What This Job Offers

• Job Type: Full-time
• Career Level: Manager