HEDIS Manager – Performance Improvement

Now hiring a Manager-Performance Improvement!

Presbyterian Healthcare is hiring a Manager-Performance Improvement. The Manager, Performance Improvement has overall responsibility for managing the daily operations of HEDIS/Star Quality and Regulatory reporting within the Performance Improvement Department.
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This key position works in collaboration with a variety of entities, departments, administration, and leadership bodies to ensure organizational improvement efforts align with accrediting, licensing, and legal requirements. This position provides program management and subject matter expertise for complex analytics and reporting in support of the annual HEDIS submission for Managed Care Organizations (MCOs), Medicare Star Program Ratings, NCQA accreditation, and regulatory and contractual compliance. This position collaborates with the Director of Performance Improvement, the HEDIS contracted Vendor, and the Analytics Operations department to ensure timely and accurate reporting to meet accreditation and regulatory requirements, and performance measure targets.

How you belong matters here.

We value our employees' differences and find strength in the diversity of our team and community.

At Presbyterian, it's not just what we do that matters. It's how we do it - and it starts with our incredible team. From Information Technology to Food Services and beyond, our non-clinical employees make a meaningful impact on the healthcare provided to our patients and members.

Why Join Us

• Full Time - Exempt: Yes
• Remote work from home: This job is intended to be conducted in the state of New Mexico.
• Remote work from home: this job is intended to be conducting in the state of New Mexico.
• Work hours: Days
• Benefits: We offer a wide range of benefits including medical, wellness program, vision, dental, paid time off, retirement and more for FT employees.

Prefer Qualifications

• Five years working in the healthcare field
• Two years of experience in HEDIS and CMS STARS regulatory submissions
• Two years of supervisor/manager experience in a healthcare setting
• Master’s degree in health related or business administration field (i.e., public health, health care administration)
• Intermediate/advanced skills in Microsoft Office

• Bachelors degree in Business, Healthcare, or related field required. 6 years of additional experience can be substituted in lieu of a degree. Master s degree preferred.
  
  
• Minimum of five years in healthcare/managed care industry with experience in HEDIS/Medicare Star performance measurement, analytics, reporting, and forecasting required.
  
  
• Two years of prior supervisory or program/project manager experience required.
  
  
• Experience presenting to leadership teams, clinicians, and employer groups also required.

 

• In collaboration with Director of Performance Improvement and Senior Leadership, determines an approach to securing and maintaining an annual Medicare Advantage Star Rating of 4.0 or higher, meeting 100% of Medicaid Performance Measure targets as established by New Mexico Health Care Authority (HCA) and other States, and ensuring the maintenance of NCQA health plan accreditation for all lines of business.
• Works with Director of Performance Improvement to provide direction, coordination, implementation, execution, and completion of HEDIS and Medicare Star programs ensuring consistency with accreditation and regulatory requirements, along with company strategy, commitments, and goals.
• Provides subject matter expertise in HEDIS and CMS STARS and assures continual performance improvement in QA / QI activities while furthering the vision, values and strategies of Presbyterian Healthcare Services (PHS)
• Promotes PHS Quality strategies and compliance with policies and standards, adopted accreditation standards and federal / state regulatory requirements
  
  

All benefits-eligible Presbyterian employees receive a comprehensive benefits package that includes medical, dental, vision, short-term and long-term disability, group term life insurance and other optional voluntary benefits.

Wellness
Presbyterian's Employee Wellness rewards program is designed to provide you with engaging opportunities to enhance your health and activate your well-being. Earn gift cards and more by taking an active role in our personal well-being by participating in wellness activities like wellness challenges, webinar, preventive screening and more.

Why work at Presbyterian?
As an organization, we are committed to improving the health of our communities. From hosting growers' markets to partnering with local communities, Presbyterian is taking active steps to improve the health of New Mexicans.

About Presbyterian Healthcare Services
Presbyterian exists to improve the health of patients, members, and the communities we serve. We are locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, we are the state's largest private employer with nearly 14,000 employees - including more than 1600 providers and nearly 4,700 nurses.

Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans.

AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.

USD $63.87/Hr.

The compensation range for this role takes into account a wide range of factors, including but not limited to experience and training, internal equity, and other business and organizational needs.