Virginia Premier Health Plan, Inc.

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Senior Manager, HEDIS Outcomes and Member Engagement

Senior Manager, HEDIS Outcomes and Member Engagement

Job Locations 
US-VA-Glen Allen
Job ID 
2017-4197

Job Description

Overview

The HEDIS Member Engagement Manager will support the Director of Population Health Outcomes in all quality activities related to HEDIS measures and member engagement and interventions to include, but not limited to efforts associated with or required by the National Committee for Quality Assurance (i.e. NCQA), which includes the Healthcare Effectiveness Data and Information Set (i.e. HEDIS), a registered trademark of NCQA, the Department of Medical Assistance Services (i.e. DMAS), the Centers for Medicare and Medicaid Services (i.e. CMS) and other required entities associated with or required by the State and/or Federal Government. Responsible for the development and implementation of short and long term programs/initiatives to improve member experience and engagement and quality of service which impacts HEDIS/STAR measures. 

 

The HEDIS Member Engagement Manager will assist leadership in establishing the Quality Performance Initiatives on impacting HEDIS measures and Consumer and Health Plan Surveys (CAHPS) ratings. The incumbent will assist in the oversight and management of implementing quality strategies for closing care gaps. This role works closely and collaboratively with various functional areas of the organization to achieve the goals and objectives of the Quality Program. Travel is mandatory.

 

Medical Management

Medical Management educates members and empowers them to become active participants in their coordinated health care plans.  This team of knowledgeable professionals in their field provide services to include Utilization Review, Medical Outreach, Case Management, Disease Management, Credentialing, Social Work as well as Grievance and Appeals

 

Responsibilities

  • Manage day to day operations related to HEDIS measures and member engagement to include development and evaluation of member interventions across the enterprise.
  • Implement effective methodologies, identify barriers and efficient interventions to overcome barriers for member engagement.
  • Develop intervention strategies and assess outcomes consistent with continuous process improvement.
  • Maintain and generate all production reports and metrics on a monthly basis, while assessing trends, identifying barriers and implementing improvement strategies
  • Design, develop and implement quality improvement activities, as required
  • Develop HEDIS, STAR, CAHPS, and HOS member engagement strategies. 
  • Works collaboratively with network providers/practitioners to execute the implementation of the clinical quality initiatives such as electronic medical record (eMR) data abstraction and transmission
  • Adhere to and enforce VPHP policies and procedures
  • Implement clinical and operational initiatives through a multidisciplinary approach within the Quality department to ensure compliance with NCQA, DMAS and CMS standards
  • Lead HEDIS related projects (or other projects as deemed appropriate) and implement interventions using a multidisciplinary approach to achieve quality outcomes

Qualifications

MINIMUM EDUCATION REQUIREMENTS:

  • Bachelor’s degree in nursing or health care field
  • Registered Nurse; licensed in State of Virginia
  • Three or more years of management experience preferred

SPECIAL KNOWLEDGE AND/OR SKILLS:

  • One year HEDIS/STAR experience or participation with regulatory reporting.
  • Healthcare Quality Improvement experience.
  • Proven HEDIS Medical Record Abstraction Experience  (Highly Preferred)
  • Proven Member and Practitioner/Provider HEDIS Education (Highly Preferred)
  • Proven Member Engagement Experience (Highly Preferred)

WORK BACKGROUND EXPERIENCE:

  • HEDIS project management, design and implementation experience
  • Experience interacting with physicians and other healthcare providers
  • Excellent training and presentation skills with solid communication capabilities and practices, both oral and written
  • Three or more years of experience extracting and analyzing quality data
  • Clinical experience
  • Managed care experience to include conducting health plan audits
  • Multi-Tasking experience is required

PHYSICAL REQUIREMENTS

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

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. 

 

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.  

 

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. EOE

 

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

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