Senior HEDIS Manager

Texas Children's Careers•Houston, TX

15d

About The Position

We’re searching for a Senior HEDIS Manager, someone who works well in a fast-paced setting. In this position, you’ll be responsible for overseeing, maintaining, and supporting the department's active programs, which include but are not limited to: Quality Improvement Initiatives (QIAs), accreditation CAPs, quality escalations, regulatory notices, intra-departmental shared operations, accreditation oversight, and others. Think you’ve got what it takes?

Requirements

Bachelor’s degree in healthcare, healthcare administration or related business degree required
5 years of experience in a health plan with quality improvement, health plan accreditation and or regulatory reporting required
3 years of experience as a program manager or related role with oversight of multiple programs required

Nice To Haves

CPHQ - Cert-Cert Prof Healthcare Qual by The Certified Professional in Healthcare Quality preferred

Responsibilities

Leads quality strategy meetings related to assigned projects and quality initiatives
Assures compliance with QI work plans
Maintains effective documents of research programs to meet regulatory and accreditation standards
Leads interactions with regulators or oversight entities including related accreditation vendors
Leads efforts to identify best practices, Identifies potential issues, project change and scope
Manages audits to ensure compliance with NCQA standards and regulatory initiatives
Conducts regularly scheduled audits of the quality programs and initiatives (QIAs)
Conducts internal audits to ensure required regulatory and accreditation metrics are being met and protocols are being followed
Manages and reports on all clinical and non-clinical program reports and metrics on a standard frequency
Escalates to leaders when metrics are unmet and outliers are identified. Assists with conducting root cause analysis
Creates policies, procedures, job aids, and training materials to stand up new program
Collaborates with Education to ensure trainings are deployed to internal and external teams
Communicates with co-workers on joint projects and initiatives
Incorporates ongoing changes to accreditation and regulatory documents trackers