Manager, Clinical Data Acquisition - Quality / HEDIS (Remote)

$65,792 - $142,549/Yr

Molina Healthcare - Bowling Green, KY

Full-time - Manager

Remote - Bowling Green, KY

Insurance Carriers and Related Activities

About the position

The Manager of Clinical Data Acquisition at Molina Healthcare plays a pivotal role in overseeing the quality improvement initiatives and education programs within the organization. This position is responsible for ensuring that healthcare quality standards are maintained for members, which includes conducting data collection, reporting, and monitoring for key performance measurement activities. The manager will also provide direction and implementation of NCQA accreditation surveys and ensure compliance with federal and state quality improvement activities. In this role, the manager will utilize their knowledge and technical expertise to manage the critical processes involved in performance measurement data collection, reporting, and monitoring, particularly focusing on HEDIS and state-based measure reporting. The responsibilities include managing annual HEDIS data collection activities, which involves responding to RFPs, developing HEDIS measures matrix, work plans, and product timelines. The manager will collaborate with various departments within Molina, including Claims, Enrollment, and IT, as well as external auditors and vendors to ensure the accuracy and soundness of the data used to generate HEDIS results. Additionally, the manager will oversee the annual CAHPS survey process and other organizational survey activities, ensuring that quality assurance is performed on generated reports. They will manage medical record review and performance measurement reporting projects, ensuring that timelines are met and that the strategies for HEDIS seasons are effectively defined. The role may also involve implementing improvement activities related to HEDIS and CAHPS processes, coordinating with relevant departments and committees to identify and recommend potential clinical measurement and quality improvement activities. The manager will maximize the use of information from various sources, including claims, pharmacy, and clinical indicators, to submit data to external agencies and quality committees within required timeframes.

Responsibilities

• Manage annual HEDIS data collection activities, including responding to RFPs and developing HEDIS measures matrix and work plans.
• Collaborate with the Director to manage contacts within Molina and external vendors to ensure appropriate responses and manage contracts and projects.
• Ensure the soundness and correctness of data used to create HEDIS results by working with corporate resources and relevant vendors.
• Oversee the state's annual CAHPS survey process and other organizational survey activities, such as the Provider Satisfaction Survey.
• Perform quality assurance for generated reports, including performance measurement rates.
• Manage medical record review and performance measurement reporting projects, ensuring timelines are met.
• Define the use of in-house vs. vendor strategy for each HEDIS season.
• Implement improvement activities related to HEDIS and CAHPS processes, coordinating with appropriate departments and committees.
• Identify and recommend potential clinical measurement and quality improvement activities.
• Maximize the use of information from multiple sources to submit data to external agencies and quality committees.

Requirements

• Bachelor's Degree or equivalent work experience.
• 7+ years experience in managed healthcare Quality/HEDIS project management and HEDIS Audit.
• Demonstrated knowledge of and experience with HEDIS programs.
• Proficiency with data manipulation and interpretation.
• Proficiency with Excel and Visio, with the ability to learn new information systems and software programs.

Nice-to-haves

• Master's Degree or higher in a clinical field, Public Health or Healthcare.
• STARS improvement experience.
• CAHPS improvement experience.
• 3+ years health care information systems experience or in a role as an IS liaison/contact for QI projects.
• State QI experience.
• Supervisory experience.
• Project management and team building experience.
• Experience developing performance measures that support business objectives.
• Certified Professional in Health Quality (CPHQ)

Benefits

• Competitive benefits and compensation package.