Virginia Premier Health Plan, Inc.

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Director, HEDIS

Director, HEDIS

Job Locations 
US-VA-Glen Allen
Job ID 
2017-4110

Job Description

Overview

The HEDIS Program Director has overall responsibility for leading the year round daily operations of HEDIS analytics team within the Quality Department. This key position collaborates across departments, administration, and leadership bodies to ensure organizational improvement efforts align with accrediting, licensing, and legal requirements. This position provides guidance and support for complex analytics and reporting in support of the annual HEDIS submission for Virginia Premier. This position collaborates with the Vice President of Population Health Outcomes to coach, mentor and lead a team of Quality Specialist to ensure timely and accurate reporting to meet regulatory requirements, and performance measure targets.

Responsibilities

  • Determines an approach implementing a year round HEDIS strategy that incorporates Quality holistically throughout the organization.
  • Provides direction, coordination, implementation, execution, and completion of HEDIS programs ensuring consistency with accreditation and regulatory requirements; along with company strategy, commitments, and goals.
  • Determines an approach implementing a year round HEDIS strategy that incorporates Quality holistically throughout the organization. 
  • Provides direction, coordination, implementation, execution, and completion of HEDIS programs ensuring consistency with accreditation and regulatory requirements; along with company strategy, commitments, and goals.
  • Assists with data analysis and reporting for delivery to Executive Leadership and company stakeholders.
  • Conducts timely analysis of regulatory materials and ensures all reporting deliverables are met.
  • Works with department leadership to assist with the development of initiatives to increase HEDIS rates
  • Minimizes risk levels by assisting with the interpretation, prioritization, development and deployment of work that meets or exceeds contractual requirements and CMS program requirements.
  • Assists leaders in identifying opportunities for improvement to address areas of vulnerability related to performance outcomes.
  • Manages contractual relationship with NCQA-certified HEDIS vendor and HEDIS auditor.
  • Manages program expectations, frequency and content of status reports to track annual HEDIS milestones and deliverables, and develops best practices and tools for performance measure reporting and management.
  • Leads preparations for the annual HEDIS Compliance Audit and serves as the point of contact during the audit process.
  • Oversees data abstraction and medical record review processes (including those conducted by NCQA-certified HEDIS vendor); and identification of critical issues and process improvements to optimize measure results.
  • Serves as a subject matter expert on HEDIS measures and the annual HEDIS process, as well as the Medicare Star program and annual rating process for Star and NCQA.
  • Identifies, plans for, communicates, monitors and evaluates actions to comply with existing and new regulations, standards and accreditation requirements throughout PDS.
  • Provides training related to quality performance measures to Executive Leadership, and staff. Also collaborates with Network Development in providing training to community vendor partners to further their understanding of measures and measure improvement opportunities.

Qualifications

MINIMAL FORMAL EDUCATION REQUIRED

  • Bachelor’s degree.
  • Masters degree highly preferred

 

SPECIAL KNOWLEDGE AND/OR SKILLS

  • Proven leadership skills
  • Ability to organize, prioritize tasks and develop systems to meet objectives of the department, company, and business associates.
  • Strong organizational, analytical and interpersonal skills
  • Managed care experience required

 

WORK BACKGROUND/EXPERIENCE REQUIRED

 

  • Minimum of five years in healthcare/managed care industry with experience in HEDIS/Medicare Star performance measurement, analytics, reporting and forecasting required.
  • Experience presenting to leadership teams, clinicians, and employer groups also required.

 

PHYSICAL REQUIREMENTS

  • Physical health sufficient to meet the ergonomic standards and demands of the position.

 

 

We offer competitive salaries and a comprehensive benefits package to include excellent Medical, Dental and Vision Plans, Tuition Assistance, Infant-At-Work Program, Remote Work options and generous vacation and sick leave policies. Our culture supports an environment where employees can continuously learn and gain professional growth through various development programs, education, exciting projects and career mobility.  

 

Our mission is to inspire healthy living within the communities we serve!

 

About Us

Virginia Premier Health Plan, Inc. is a managed care organization which began as a full-service Medicaid MCO in 1995. Partnered with VCU Medical Systems we strive to meet the needs of the underserved and vulnerable populations in Virginia by delivering quality driven, culturally sensitive and financially viable Medicare and Medicaid healthcare programs. Headquartered in Richmond, VA we also have offices in Roanoke, Tidewater and Bristol with additional satellite locations allowing us to serve over 200,000 members across eighty counties throughout Virginia. 

 

Equal Opportunity Employer All qualified applicants will receive consideration for employment without regard to age, race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.

 

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