Elevance Health - Mendota Heights, MN
posted 2 months ago
Full-time - Mid Level
Mendota Heights, MN
11-50 employees
Insurance Carriers and Related Activities
About the position
The HEDIS Clinical Quality Program Manager is responsible for overseeing quality improvement activities related to HEDIS Roadmap Section 5 for multiple states within a major line of business. This role involves leading strategy meetings, developing work plans, ensuring compliance with quality improvement initiatives, and managing data collection and audit processes to enhance the quality of care for members.
Responsibilities
- Lead HEDIS Section 5 quality strategy meetings and develop a workplan.
- Ensure management of supplemental data processes.
- Develop performance improvement plans and oversee clinical quality improvement activities.
- Assure compliance with corporate QI work plans and HEDIS audit timelines.
- Manage workplan, timelines, and coordination with other business areas on data collection and documentation.
- Maintain effective documentation to meet regulatory and Accreditation Standards.
- Provide oversight for accurate quantitative analysis of clinical data and presentation of results.
- Participate in the development of new product designs for major lines of business.
- Oversee the implementation of new initiatives.
- Lead interactions with auditors and regulators.
Requirements
- BS in health administration, nursing, or a related clinical field.
- 4 years of health care quality or data analysis experience, or equivalent education and experience.
Nice-to-haves
- Experience with the HEDIS submission process including the NCQA HEDIS Roadmap.
- Technical experience in HEDIS data collection guidelines.
- In-depth understanding of regulatory standards and guidelines pertinent to healthcare data and quality reporting.
- Experience working with Medicaid and Medicare plans.
Benefits
- Merit increases
- Paid holidays
- Paid Time Off
- Incentive bonus programs
- Medical benefits
- Dental benefits
- Vision benefits
- Short and long term disability benefits
- 401(k) with matching
- Stock purchase plan
- Life insurance
- Wellness programs
- Financial education resources
