The Sr .Manager, Population Health (Quality) 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 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
MINIMUM EDUCATION REQUIREMENTS:
SPECIAL KNOWLEDGE AND/OR SKILLS:
WORK BACKGROUND EXPERIENCE:
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
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