Manager, HEDIS Strategy & Program Management/ Job Req 772070814

PRINCIPLE RESPONSIBILITIES:

Under the general direction of the Director, Stars Strategy & Program Management, the Manager, HEDIS Strategy & Program Management, is responsible for the planning, implementation, strategic oversight, and evaluation of HEDIS and Stars performance improvement strategies for Alameda Alliance for Health's (the Alliance) Medicare Advantage Dual Eligible Special Needs Plan (D-SNP) product. This individual will have a deep understanding of HEDIS measures, Medicare Star Ratings, and quality improvement methodologies to optimize quality outcomes and drive overall plan performance. The Manager, HEDIS Strategy & Program Management, will work cross-functionally to design, implement, and monitor effective programs that enhance HEDIS and Star ratings, ensuring alignment with regulatory requirements and organizational goals. The Manager, HEDIS Strategy & Program Management, is expected to remain current with market/industry trends and the competitive product landscape to ensure the HEDIS strategies are implemented in a budget conscience, quality, and timely manner.

Principle responsibilities include:

• Working with Director of Stars Strategy to lead the design and implementation of HEDIS and Stars strategy initiatives for the Alliance and Medicare Advantage D-SNP product that is consistent with the vision and mission of the Alliance.
• Identifying and prioritizing key HEDIS measures to optimize Star ratings and develop strategies to address gaps in care and improvement opportunities.
• Continuously monitoring the execution of targeted intervention programs that improve member engagement, increase preventative service utilization, and close care gaps.
• Acting as a liaison and SME between the key stakeholders in a matrixed environment to drive intervention program adoption and commitment.
• Utilizing data analytics to identify insights, track progress, and inform decision making for HEDIS and Stars initiatives.
• Overseeing performance, reporting, and analysis of HEDIS and Star measures to identify trends, risks, and improvement activities.
• Supporting Go-Live activities to include system testing and configuration when necessary, demonstrating trained processes.
• May facilitate training sessions to increase employee and provider knowledge and competence, using visual aids such as videos, slides, graphs, charts, presentations, etc.
• Fostering a collaborative environment within the organization to promote innovative thinking and best practices as it relates to HEDIS and Star strategy.
• Working cross-functionally with diverse staff in teams, working groups, members, doctors, elected officials, community partners, and vendors while maintaining and upholding a professional demeanor and representing the Alliance at interviews, special events, official functions, meetings, and when conducting research.
• Assisting in creating policies, standard operating procedures (SOPs), productivity standards, roadmaps, reporting, and Key Performance Indicators (KPIs) in a timely manner.

ESSENTIAL FUNCTIONS OF THE JOB:

• Assumes responsibility and exercises good judgement in making decisions within the scope of authority of the position.
• Proficient in understanding the NCQA technical specifications as it relates to HEDIS measures and their impact to Star ratings methodology.
• Demonstrates strong organizational, time management, and project management skills and multi-tasking abilities.
• Proven track record of developing and implementing successful HEDIS interventions with a focus on improving Star ratings.
• Provides support to the Project Management Office (PMO) and various enterprise-wide activities based on availability.
• Organizes and facilitates HEDIS and Stars project-related meetings, as necessary.
• Works effectively independently as well as part of a team and supports team decisions.
• Adapts to changes in requirements/priorities for daily and specialized tasks.
• Produces accurate and precise work, detects discrepancies, and resolves discrepancies all while meeting deadlines.
• Demonstrates analytical skills and problem-solving skills as well as formulates and communicates recommendations for improvements as needed.

PHYSICAL REQUIREMENTS:

• Constant and close visual work at a desk or a computer.
• Constant sitting and working at a desk.
• Constant data entry using a keyboard and/or mouse.
• Frequent use of a telephone headset.
• Constant verbal and written communication with staff and other business associates by telephone, correspondence, or in person.
• Frequent lifting of folders and other objects weighing between 0 and 30 lbs.
• Frequent walking and standing.
• Occasional driving of automobiles.

Number of Employees Directly Supervised: 0-5

Number of Employees Indirectly Supervised: 0-5

MINIMUM QUALIFICATIONS:

EDUCATION OR TRAINING EQUIVALENT TO:

• A Bachelor's degree in health administration, public health, nursing, related field, or equivalent work experience.

MINIMUM YEARS OF ADDITIONAL RELATED EXPERIENCE:

• Minimum of five (5) years of experience in quality improvement, with specific experience in HEDIS and Stars.
• Minimum of three (3) years of experience in the managed care industry with Medicare Advantage related experience preferred.

SPECIAL QUALIFICATIONS (SKILLS, ABILITIES, LICENSE):

• Audit experience preferred.
• Supervisory experience preferred.
• Experience in project management, program management, or product development preferred.
• Strong understanding of HEDIS measures, CMS Star Rating methodology, and regulatory requirements.
• Excellent written, verbal, and interpersonal communication skills, and ability to successfully interact with people at all levels.
• Ability to facilitate meetings, manage complex initiatives, and make presentations before groups consisting of management and staff.
• Exhibits good planning and implementation skills to ensure work is completed on time and to expected quality levels.
• Strong collaboration skills with demonstrated ability to create and foster a collaborative work environment, while maintaining effective, high-performance teams.
• Strong organizational skills with the ability to effectively prioritize multiple tasks and meet deadlines.
• Ability to lead effectively in a matrixed environment.
• Ability to communicate effectively orally and in writing.
• Basic knowledge of the business, economic, demographic, and political trends and developments affecting healthcare in general.
• Intermediate skills in Microsoft Office Suite including Outlook, Word, Excel, Visio, and PowerPoint.
• Ability to manage confidential information with appropriate discretion.
• 5% to 10% occasional travel required.
• Valid CA driver's license, proof of insurance and good driving record.

SALARY RANGE: $142,043.20 - $213,075.20 annually

The Alliance is an equal opportunity employer and makes employment decisions on the basis of qualifications and merit. We strive to have the best qualified person in every job. Our policy prohibits unlawful discrimination based on race, color, creed, gender, religion, veteran status, marital status, registered domestic partner status, age, national origin or ancestry, physical or mental disability, medical condition, genetic characteristic, sexual orientation, gender identity or expression, or any other consideration made unlawful by federal, state, or local laws. M/F/Vets/Disabled.