Manager HEDIS Program - Remote

• Manages the HEDIS Program including requirement gathering, creation of project plans and schedules, obtaining and managing resources, facilitating project execution, deployment, and closure.
• Stays current with HEDIS guidelines and requirements, and best practices related to the execution of the HEDIS Roadmap.
• Prepares accurate and timely reports on HEDIS performance for internal and external stakeholders, management, and regulatory bodies.
• Maintains detailed project documentation in accordance with the NCQA HEDIS technical specifications, and HEDIS compliance audit standards, policies, and procedures.
• Develops and implements strategies to validate supplemental data sources used in HEDIS operations, ensuring accuracy and reliability.
• Works closely with vendors to ensure accuracy and validity of data obtained from external sources.
• Creates and maintains a tracking system to document records of annual primary source verification activities, ensuring compliance with regulatory requirements.
• Maintains a robust medical record review program to assess the quality of care provided by healthcare providers.
• Develops and implements comprehensive auditing procedures to evaluate the accuracy and completeness of medical record documentation.
• Analyzes medical record review findings and identifies opportunities for process improvement.
• Manages the HEDIS team including coaching, professional growth and development, conducting performance evaluations and providing regular feedback to team members.

• Bachelor’s degree in health care or other related field; Master’s Degree preferred
• A minimum of five (5) years of experience in the health care industry, in HEDIS and/or quality improvement.
• Experience in managed care health services environment.
• Demonstrated knowledge of data collection, medical record review, and data extraction.
• NCQA and HEDIS Experience.
• Project management experience in a healthcare regulated or accredited environment.
• Experience writing and editing regulatory policies and procedures as outlined by a governing body such as NCQA, TRICARE, or CMS.

• Active and unrestricted RN licensure.

• Demonstrates ability to manage teams and multi-disciplinary workgroups in achieving team objectives, without direct authority.
• Ability to delegate responsibility, set priorities, and establish accountability.
• Knowledge of CMS, DHA and NCQA quality programs.
• Strong critical thinking, problem-solving and project management skills; ability to develop and implement solutions.
• Ability to gather, interpret and present data to teams, senior leadership, and external partners.
• Possesses ability to interpret and simplify communications of regulatory standards and remain up to date on changes to requirements.
• Maintains broad knowledge of industry trends and developments.
• Proactive approach and able to work independently, highly organized.
• Excellent written and oral communication skills, able to discuss negative events with others in a supportive and non-punitive manner.
• Ability to build collaborative relationships with multi-disciplinary teams supporting the achievement of objectives, without direct authority.
• Inspires others toward the goal of continuous quality and safety improvement.
• Manages multiple competing demands, able to prioritize and make sound decisions.
• Competence with computers and business applications: Microsoft Outlook, Excel, Word, and Power Point.
• Demonstrates understanding of and alignment with Martin’s Point values.

Martin’s Point Health Care