National Manager Quality HEDIS Stars

P3 Health Partners - Tucson, AZ

Full-time - Mid Level

Tucson, AZ

Ambulatory Health Care Services

About the position

At P3 Health Partners, we are a physician-led organization dedicated to transforming health care from sickness care into wellness guidance. We are seeking a National Manager of Quality for HEDIS/Stars to coordinate our quality management program in compliance with regulatory requirements and NCQA accreditation standards. This role involves working within highly matrixed relationships to implement and maintain the core infrastructure of our quality management program. The position is based in Las Vegas, NV, and is ideal for someone who is passionate about their work and eager to be part of a fast-growing organization.

Responsibilities

• Oversees the implementation of plan quality management components, executed by the market Provider Engagement teams, for affiliates and employed medical groups
• Proactively manages and responds to rapidly changing CMS requirements and environments
• Collaborates across business segments to attain or maintain the plan's compliance with CMS, NCQA, PQA standards and contractual requirements as they apply to the quality management program (HEDIS, Part D/Patient Safety, and Patient Experience)
• Develops and maintains positive relationships with health plan partners within the scope of the quality management program
• Commands a comprehensive knowledge of risk arrangements, contracts, member and provider benefit structure
• Ensures the creation and submission of reports to meet health plan contractual requirements
• Monitors HEDIS reporting requirements and annual reporting processes to confirm alignment with regulatory expectations and successful annual submission
• Identifies gaps in patient care to better direct provider and patient engagement for CMS Star Rating
• Prepares presentations and data, in collaboration with market leaders, for health plan and affiliate Joint Operating Committees and materials to be used for Provider education sessions
• Develops strategies for quality improvement opportunities, including HEDIS and Part D/Patient Safety gap closure and patient experience
• Maintains and develops strong collaborative relationships with payors, network providers/affiliates, vendors, and internal P3 Health Partner teams to ensure health data is accurate and complete and outcomes are met related to quality
• Leads analytical and technical support for the development and data capture of Quality Measures
• Conducts in-depth analyses to target potential interventions or initiatives to improve health plan members quality of care and experience
• Engages Network Providers, vendors, payers, and internal P3HP departments to educate, train, and achieve improved CMS Star Rating
• Tracks and reports KPIs and KAIs to achieve improved CMS Star Rating
• Other job duties as assigned

Requirements

• Bachelor's degree in healthcare related field, or comparable experience
• 3+ years of experience with demonstrated functional knowledge related to regulatory adherence of a quality management program (HEDIS, Part D/Patient Safety, NCQA, Stars, auditing, reporting, committee management)
• Must be able to travel within Nevada, Arizona, Oregon, and California markets as needed
• Experience leading Quality teams or similar supervisory experience
• Experience making formal presentations in front of committees and work group environments and using virtual technology (e.g., Microsoft Teams/Zoom)
• Advanced level proficiency in software applications that include, but are not limited to, Microsoft Word, Excel, Outlook, and PowerPoint
• Proven solid written and oral communication skills with internal and external partners and employees
• Effective project management skills in creating, evaluating, and improving strategies for project execution

Nice-to-haves

• Master's degree in healthcare, or similar area
• Certified Professional in Healthcare Quality
• Experience in bringing together cross-functional teams to complete projects