Senior Manager, Health Care Quality

Aetna Medicaid Administrators

5d

About The Position

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day. The Senior Manager Health Care Quality Management will support the functions of the Fully and Highly Integrated Duals Eligible (FIDE/HIDE) quality program, including regulatory deliverables, HEDIS activities and reporting and other quality improvement activities. Providing support to staff and communicate with departments across the health plan to facilitate daily quality improvement (QI) functions. This role will support both existing health plans and newly implemented markets. Coordinate and monitor quality improvement and organizational projects from inception to closure including quality withhold performance and Healthcare Effectiveness Data and Information Set (HEDIS) preparation. Coordinate and monitor quality work plan activities for both NCQA, state and federal compliance. Manage the annual quality program trilogy documents (program description, workplan, program evaluation) to ensure inclusion of annual goals. Ensure all quality policies are updated annually and in compliance with state contract. Collaborate with all internal and external stakeholders in identifying, developing, and implementing innovative programs and initiatives to improve outcomes. Analyze data, develop reports and present to plan committees. Design, run, and manage the data review process to ensure accuracy and integrity of data reports to meet regulatory and operational requirements. Coordinate and implement interventions to increase HEDIS, CAHPS, quality improvement projects and designated health measures for the Plan. Adhere to NCQA standards and work with National Quality Management Accreditation team to maintain the plan's NCQA accreditation. Support the coordination of corporate compliance and external surveys as needed. Support the project life cycle including requirements gathering, creation of project plans and schedules, manage resources, support HEDIS audit process, and facilitate project execution, deployment and closure. Participate in vendor oversight meetings with contracted vendors. Coordinate all data pulls and ongoing data management for HEDIS and QI project management databases for identified QI projects with department staff and corporate contacts. Evaluate sources for alternative data capture; assess ongoing methodology and results.

Requirements

• 7+ years of experience in healthcare quality, quality improvement, and performance measurement.
• Proficiency in Microsoft Office Suite
• Demonstrated ability to analyze and interpret complex data sets and convert findings into actionable insights.
• Excellent time management, planning and organizational skills.
• Strong written and verbal communication skills.
• Ability to work independently and collaboratively in a fast-paced environment.

Nice To Haves

• Experience presenting to leaders and/or leadership teams
• Experience with Medicare Stars, HEDIS, or NCQA reporting.
• Excellent time management, planning and organizational skills.
• Reside in the state of Nevada

Responsibilities

• Support the functions of the Fully and Highly Integrated Duals Eligible (FIDE/HIDE) quality program
• Coordinate and monitor quality improvement and organizational projects from inception to closure
• Coordinate and monitor quality work plan activities for both NCQA, state and federal compliance
• Manage the annual quality program trilogy documents
• Ensure all quality policies are updated annually and in compliance with state contract
• Collaborate with all internal and external stakeholders in identifying, developing, and implementing innovative programs and initiatives to improve outcomes
• Analyze data, develop reports and present to plan committees
• Design, run, and manage the data review process to ensure accuracy and integrity of data reports to meet regulatory and operational requirements
• Coordinate and implement interventions to increase HEDIS, CAHPS, quality improvement projects and designated health measures for the Plan
• Adhere to NCQA standards and work with National Quality Management Accreditation team to maintain the plan's NCQA accreditation
• Support the coordination of corporate compliance and external surveys as needed
• Support the project life cycle including requirements gathering, creation of project plans and schedules, manage resources, support HEDIS audit process, and facilitate project execution, deployment and closure
• Participate in vendor oversight meetings with contracted vendors
• Coordinate all data pulls and ongoing data management for HEDIS and QI project management databases for identified QI projects with department staff and corporate contacts
• Evaluate sources for alternative data capture; assess ongoing methodology and results

Benefits

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

What This Job Offers

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