Manager, HEDIS - Denver Health Medical Plan ( Weekly Hybrid Schedule )

Denver Health•Denver, CO

9d•$98,600 - $152,800•Hybrid

About The Position

We are recruiting for a mission-driven Manager, HEDIS - Denver Health Medical Plan ( Weekly Hybrid Schedule ) to join our team! We're with you for life’s journey. At Denver Health, purpose isn’t just something we believe in—it’s something we live every day, for life’s journey. Our Values Respect | Belonging | Accountability | Transparency Department Managed Care Administration This is a hybrid role with a requirement to be in-office 3 days per week in Denver, Colorado. Colorado residency required.

Requirements

Bachelor's degree In nursing, health informatics, healthcare administration, public health or related field required
4-6 years Project Management experience, preferably in HEDIS/HOS within a managed care environment required
4-6 years previous experience in performing medical record review, inter rater reliability and working knowledge of medical terminology and NCQA HEDIS Technical Specifications required
4-6 years previous experience with HEDIS quality measurements for health plan STAR ratings
4-6 years previous experience in healthcare, quality improvement, statistics and/or evaluation.
Extensive knowledge of MCR Stars program and NCQA accreditation process including previous experience with HEDIS quality measurements, health plan STAR ratings and quality reporting
Knowledge/familiarity with medical terminology, medical record review, NCQA HEDIS Technical specifications, and decision making skills regarding appropriateness of care review.
Ability to work independently as well as collaboratively with other internal and external team members to ensure timelines are met
Demonstrated leadership skills in working with clinical professionals and office staff
Ability to coach and lead others on a collaborative basis to ensure team success
Ability to engage physicians, advance care providers, vendors, clinical leaders, and other key stakeholders to deliver member-centered care.
Demonstrate flexibility in response to unexpected changes.

Nice To Haves

Colorado residency required.

Responsibilities

Oversees the HEDIS/ HOS data collection, development and analysis; maintains and updates appropriate data collection systems and enters information, as required, using MS Office, and Managed Care systems used to extract data for HEDIS/ HOS while driving and providing oversight of post-audit reviews to define operational improvements for future HEDIS cycles. Ensures compliance with all NCQA HEDIS Audit requirements.
Support strategic goals of MCR Stars by providing subject matter expertise on quality metrics and HEDIS strategy
Support NCQA accreditation process by providing subject matter expertise on quality standards
Work with providers on appropriate coding and documentation for HEDIS Stars and MLR measures. Oversee post-audit reviews to define operational improvements for future HEDIS cycles.
Determines work procedures and expedites workflow; assigns duties and reviews work; prepares necessary and required reports to management. Delegates responsibility/authority. Identifies problems and opportunities for improvement; identifies appropriate solution and involves others in the implementation process. Makes recommendations for cost efficiency and process improvement. Meets all NCQA HEDIS Medical Record Review (MRR) requirements and deadlines.
Prepares and/or reviews daily, weekly, monthly and quarterly quality assessment reports and conducts/reports findings for QI data for all lines of business as required for HEDIS/ HOS activities, lead discussions about data/results, provides timely updates. Meets NCQA Compliance Audit activities to include annual training/testing of HEDIS staff and timely completion of Supplemental Data Audit (SD), Medical Record Review Validation (MRRV, Inter-Rater Reliability (IRR) tracking, and supports HEDIS annual roadmap submission.
Partners with vendors and manages tracking progress during and prior to submission such as HEDIS auditor and Hedis Data vendor for medical record capture
Creates annual HEDIS training and testing materials per NCQA Technical Specification and compliance audit requirements. Identifies training and staff development needs of employees, recognizes positive behavior and contributions to the staff, using praise, appreciation and rewards, participates in the selection of QI staff, sets performance expectations by developing job specific customer service expectations and behaviors. Promotes guidance/oversight of certain tasks and delegates appropriately.
Oversee post-audit reviews to define operational improvements for future HEDIS cycles.

Benefits

Paid time off starting at 28 days per year, inclusive of vacation, personal/sick, and 7 Holidays
100% paid parental leave up to 6 weeks
Immediate eligibility for retirement plans with employer contribution up to 9.5%
Generous medical, dental, vision plans in addition to employer paid disability and life insurance.
Comprehensive well-being programs including on-site employee fitness center located on Denver Health main campus and nationally recognized RESTORE Center
Free RTD EcoPass (public transportation)
Childcare discount programs & exclusive perks on large brands, travel, and more
Tuition reimbursement & assistance
Education, coaching, and professional development opportunities through the Workforce Development Center (WFDC) that support internal career growth and advancement pathways
Professional clinical advancement program & shared governance
Public Service Loan Forgiveness (PSLF) eligible employer+ free student loan coaching and assistance navigating the PSLF program
National Health Service Corps (NHCS) and Colorado Health Service Corps (CHSC) eligible employer