Senior Manager of HEDIS, Business/Clinical Lead - Denver Health Medical Plan ( Hybrid Work Schedule )

Denver Health • Denver, CO

10d • Hybrid

About The Position

We are recruiting for a motivated Senior Manager of HEDIS, Business/Clinical Lead - Denver Health Medical Plan ( Hybrid Work Schedule ) to join our team! We are here for life’s journey. Where is your life journey taking you? Being the heartbeat of Denver means our heart reflects something bigger than ourselves, something that connects us all: Humanity in action, Triumph in hardship, Transformation in health. Department Managed Care Administration Hybrid Work Schedule Job Summary The Senior Manager, who will also function as a HEDIS Project Lead, is the accountable business and clinical owner of the HEDIS and Core Measure program across all product lines. This role is responsible for clinical interpretation of measures, reporting strategy, audit readiness, and cross-functional coordination to ensure HEDIS and Core Measure results are accurate, compliant, and defensible. This role serves as the primary authority for what is reported and why, partnering closely with the HEDIS/Core Measure Technical Lead, MRR leadership, and business stakeholders. The role operates on a year-round cadence, supporting design, validation, production, audit, and submission activities.

Requirements

• Bachelor's degree in healthcare, public health, nursing, health administration, or related field required
• 4-6 years of experience in HEDIS, quality measurement, NCQA, or healthcare quality analytics required
• 1-3 years clinical background (RN) or equivalent clinical informatics experience required
• 3-5 years previous management experience required
• Demonstrated experience interpreting HEDIS measures and NCQA requirements
• Experience supporting or participating in HEDIS audits
• Strong written and verbal communication skills, including audit-facing communication

Nice To Haves

• 7+ years of progressive HEDIS or quality program leadership experience
• Demonstrated experience interpreting CMS Core Measures and CMS reporting requirements
• Experience serving as a primary clinical lead or decision-maker during an audit
• Familiarity with HEDIS vendor platforms (e.g., Cotiviti)
• Experience supporting CAHPS processes and submissions

Responsibilities

• HEDIS Program & Clinical Leadership
• Owns overall HEDIS and CMS Core Measures clinical strategy and reporting intent across product lines
• Interprets NCQA HEDIS specifications, CMS Core Measures specifications, FAQs, and technical guidance
• Determines measure inclusion/exclusion, hybrid vs. administrative approach, and reporting decisions
• Provides clinical judgment and escalation support for complex or ambiguous scenarios
• Monitors NCQA HEDIS updates, CMS Core Measures updates, technical bulletins, FAQs, and measure changes
• Assess the impact of upcoming HEDIS and CMS Core Measure changes on organization programs, data sources, and workflows
• Partners with IS (Information Systems) to identify and ensure changes are made outside of production season: ◦ New or modified measures ◦ Required data sources or automations ◦ Requirements or simplifications of existing logic (25%)
• Medical Record Review (MRR) Oversight
• Partners with the MRR Manager on MRR strategy, reconciliation, and quality oversight (10%)
• QA / UAT (Clinical)
• Owns clinical QA/UAT for: ◦ New or modified measures ◦ HEDIS and Core Measures main software (Cotiviti) data and refreshes plus other Supplemental Data Sources (SDS) ◦ CAHPS samples and outputs
• Confirms outputs align with clinical intent prior to audit and submission (25%)
• Audit & Roadmap Ownership
• Owns business and clinical content of the HEDIS and CMS Core Measures Roadmap
• Leads clinical responses to audit questions and issue logs
• Serves as a primary clinical point of contact for external auditors (25%)
• Cross-Functional Leadership
• Works closely with IS, Product Line Managers (PLMs), Population Health/QI, MRR, and vendors
• Ensure business stakeholders are engaged early and consistently
• Supports governance and decision-making across the HEDIS and CMS Core Measure lifecycle (15%)

Benefits

• Outstanding benefits including up to 27 paid days off per year, immediate retirement plan employer contribution up to 9.5%, and generous medical plans
• Free RTD EcoPass (public transportation)
• On-site employee fitness center and wellness classes
• Childcare discount programs & exclusive perks on large brands, travel, and more
• Tuition reimbursement & assistance
• Education & development opportunities including career pathways and coaching
• 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

What This Job Offers

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