About the job
The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change.
This position is remote work eligible; Candidates MUST reside in California.
What You Will Be Doing:
Under general supervision, responsible for planning and evaluating department strategies, projects and monitoring performance goals for HEDIS, MCAS, HEQMS STARS, and Risk Adjustment activities consistent with Health Plan objectives and applicable regulatory requirements. Work is varied and moderately complex and requires a moderate degree of discretion and independent judgment.
Our Vision:
Continuously improve the health of our community.
Our Mission:
We provide healthcare value and advance wellness through community partnerships.
Essential Functions:
- Implements department objectives and action plans; monitors progress and assists with implementation of appropriate interventions based on results.
- Works in collaboration with the Manager to identify and implement consistent work processes to achieve compliance standards and continued operational readiness in accordance with NCQA HEDIS, Accreditation, State and CMS regulations.
- Provides subject matter expertise and assists with training for HEDIS, MCAS, STARS, and HEQMS measure guidelines, specifications and audit procedures for all current and new staff.
- Manages measure performance dashboards and ensures they are updated and maintained for HEDIS, MCAS, STARS and HEQMS at the Managed Care Plan level and any additional stratifications required.
- Assists with the creation and oversight of HEDIS and Stars data collection and reporting, including HEDIS Roadmaps; ensures the timely and accurate completion of deliverables.
- Compiles, develops and submits internal and external reports required for HEDIS, MCAS, STARS, and HEQMS reporting.
- Oversee the development, implementation and maintenance of appropriate and required records relevant to the project(s) at hand. This includes HEDIS hybrid and Risk/HCC collection.
- Assists in implementing and maintains department policies and procedures and communicates changes to appropriate individuals in a timely and effective manner.
- Maintains all vendor and consultant relationships related to quality measure reporting and EQRO’s to possess the ability to step in as secondary contact when needed.
- Promotes and maintains an environment that supports the health plan’s strategy, vision, mission and values.
- Maintains interdepartmental communications to ensure timely and accurate quality metric reporting.
What You Bring:
Knowledge, Skills, Abilities and Competencies
Required
- Knowledge of the health care industry especially the managed care industry and its products and services.
- In-depth knowledge of Quality Management principles and practices.
- In-depth knowledge of HEDIS, MCAS, STARS and HEQMS measures, reporting and improvement processes, and ability to implement and oversee effective programs and improvement activities.
- Strong analytical skills, including the ability to identify relevant metrics, draw conclusions and take action based on results.
- In-depth knowledge of audit, control and monitoring processes, and the ability to effectively implement and maintain them.
- Manages complexity: Makes sense of complex, high quantity, and sometimes contradictory information to effectively solve problems.
- Decision quality: Makes good and timely decisions that keep the organization moving forward.
- Strategic mindset: Sees ahead to future possibilities and translates them into breakthrough strategies.
- Ability to develop and execute goals and associated business plans.
- Resourcefulness: Secures and deploys resources effectively and efficiently; organizes people and resources to solve problems and identify opportunities.
- Plans and aligns: Plans and prioritizes work for self and others to meet commitments aligned with organizational goals.
- Ensures accountability: Holds self and others accountable to meet commitments.
- Drives results: Consistently achieve results, even under tough circumstances.
- Strong interpersonal skills, including the ability to establish and maintain effective working relationships with individuals at all levels both inside and outside of the Health Plan.
- Strong oral and written communication skills, including the ability to communicate professionally and effectively with individuals and groups inside and outside of the health plan.
- Strong presentation skills, including but not limited to the ability to tailor presentations to specific audience, and identify key messages.
- Collaborates: Builds partnerships and works collaboratively with others to meet shared objectives.
- Persuades: Uses compelling arguments to gain the support and commitment of others.
- Situational adaptability: Adapts approach and demeanor in real time to match the shifting demands of different situations.
- Being Resilient: Rebounds from setbacks and adversity when facing difficult situations.
- Strong knowledge of change management theory, with the ability to implement effectively.
- Strong project management skills and demonstrated ability to lead complex, cross functional initiatives.
- Demonstrated ability to articulate and support the health plan’s vision, mission, values and strategy, integrate into management practices, and foster their manifestation among staff.
- Strong leadership skills, with the ability to lead projects in a manner that maximizes employee performance and business results.
- Proficient in Microsoft Office suite.
- Ability to handle confidential information with appropriate discretion .
What You Have:
Education and Experience
Required
- At least three years of progressive experience in Quality Improvement, including HEDIS, STARS and/or EQRO activities.
Preferred
- Experience in quality in Medicare STARS.
- Experience leading HEDIS and STARS activities and EQRO experience, etc.
- Experience with data manipulation and visualization.
Licenses, Certifications
- None.
HPSJ Perks:
What You Will Get:
- Competitive salary
- Robust and affordable health/dental/vision with choices in providers
- Generous paid time off (accrue up to 3 weeks of PTO, 4 paid floating holidays including employee’s birthday, and 9 paid holidays)
- CalPERS retirement pension program, automatic employer-paid retirements contributions, in addition to voluntary defined contribution plan
- Two flexible spending accounts (FSAs)
- Employer-Paid Term Life and AD&D Insurance
- Employer-Paid Disability Insurance
- Employer-Paid Life Assistance Program
- Health Advocacy
- Supplemental medical, legal, identity theft protection
- Access to exclusive discount mall
- Education and training reimbursement in addition to employer-paid elective learning courses.
- A chance to work for an organization that is mission-driven – our members and community are at the core of everything we do.
- A shorter commute – if you’re commuting from the Central Valley to the Bay Area.
- Visibility and variety – you have a chance to work with people at all levels of the organization, and work on diverse projects.
We are an equal opportunity employer and diversity is one of our core values. We believe that differences including race, ethnicity, gender, sexual orientation, and other characteristics, will help us create a strong organization that is sensitive to the needs of those we serve. Employment decisions are made on the basis of qualifications and merit.
HPSJ provides equal employment opportunities to employees and applicants for employment and prohibits discrimination based on color, race, gender (including gender identity and gender expression), religion (including religious dress and grooming practices), marital status, registered domestic partner status, age, national origin (including language use) or ancestry, physical or mental disability, medical condition (including cancer and genetic characteristics), sex (including pregnancy, childbirth, breastfeeding or related medical condition), genetic information, sexual orientation, military or veteran status, political affiliation or any other characteristic made unlawful by applicable Federal, State or local laws. It also prohibits unlawful discrimination based on the perception that anyone has these characteristics or is associated with anyone who has or is perceived to have these characteristics.
Important Notice : This job description is not a contract between HPSJ and the employee performing the job. The duties listed in the job description may be changed at the discretion of HPSJ, and HPSJ may request the employee to perform duties that are not listed on the job description.