Director, HEDIS
Description:
Job Description
The Director, HEDIS will provide direction and supervision to the HEDIS team and the management team of the HEDIS team. The Director will be responsible for developing and implementation of quality measure initiatives. The goal of such initiatives is to drive superior quality measure performance scores for all lines of business (Senior MA, Commercial, Exchange, and Medi-Cal). The Director will serve as an expert resource for quality measure specifications and will provide educational updates to Providers and clinical team members. The Director will assist the team in monitoring production, identifying inefficiencies, updating workflows and managing the team. The overarching function of the Director is to oversee team member outreach efforts, provide ongoing data evaluation and progress reports to the Medical Director and to resolve any discrepancies that have been identified.
Essential Duties and Responsibilities include the following:
Provide Continuous monitoring of quality measure date (numerators and Denominators), identify data irregularities, monitor the HEDIS team and their projects.
Evaluates quality measure data information and assists in establishing priorities for outreach efforts so that goals are achieved.
Directs and supervises RMG internal outreach team in implementation of patient directed outreach efforts.
Supervises data reporting and projects being completed by the team.
Assists in the development of provider and care team directed education regarding quality measure specification details, changes and updates.
Supports the development and implementation of new programs that may be innovative in their approach to maximize success with member outreach, closure of quality measure gaps and member satisfaction scores (HOS, CAHPS).
Directs and supervises outreaches and activities regarding quality measures.
Ensures accuracy and compliance with all CMS guidelines regarding quality measure sets.
Assists in completing medical record audits and/or retrieving medical chart reviews requested by Health Plans.
Collaborates with other departments for efficient and effective processing of HEDIS material for issues and outcomes.
Coordinates care with appropriate functional areas (QI, SNP, TCM, and Pharm) for quality measure sets compliance.
Attends all meetings applicable to this position inside and outside of the organization.
Assists in managing (this includes interviewing/hiring/training/monitoring) and supporting the managers for a team of approximately 50 employees.
Communicate to patients, customers and co-workers know what they can expect from you and follow through
Be an active listener (make eye contact, validate)
Assume a neutral position and suspend judgment of others
Be accountable for your work
Summarize key information and provide written materials whenever possible
Validate to ensure understanding
Anticipate needs that will arise
All other duties as directed by management
Education and / or Experience:
Bachelor degree required.
A minimum of 5 years’ experience in a healthcare or managed care setting required.
A minimum of 3 years’ experience dedicated to HEDIS and quality measure performance strategy and/or systems analysis required.
Must know or have the ability to understand multiple software programs including, but not limited to MS Office (Word, Excel), Business Solutions, DAI Scheduling, Ascender, EZCAP, NextGen.
Excellent written and oral communication skills.
Detail oriented. Must be able to meet deadlines and be flexible to demands of the position.
Ability to work independently.
Current Driver’s License and Proof of Insurance.
The pay range for this position at commencement of employment is expected to be between $150,000 - $180,000 annually; however, base pay offered may vary depending on multiple individualized factors, including market location, job-related knowledge, licensure, skills, and experience.
The total compensation package for this position may also include other elements, including a sign-on bonus and discretionary awards in addition to a full range of medical, financial, and/or other benefits (including 401(k) eligibility and various paid time off benefits, such as vacation, sick time, and parental leave), dependent on the position offered.
Details of participation in these benefit plans will be provided if an employee receives an offer of employment.
If hired, employee will be in an “at-will position” and the Company reserves the right to modify base salary (as well as any other discretionary payment or compensation program) at any time, including for reasons related to individual performance, Company or individual department/team performance, and market factors.
As one of the fastest growing Independent Physician Associations in Southern California, Regal Medical Group, Lakeside Community Healthcare & Affiliated Doctors of Orange County, offers a fast-paced, exciting, welcoming and supportive work environment. Opportunities abound, and enterprising, capable, focused people prosper with us. We promote teamwork, nurture learning, and encourage advancement for all of our employees. We want to see you excel, because we believe that your success is our success.
Full Time Position Benefits:
The success of any company depends on its employees. For us, employee satisfaction is crucial not only to the well-being of our organization, but also to the health and wellness of our members. As such, we are firmly dedicated to providing our employees the options and resources necessary for building security and maintaining a healthy balance between work and life.
Our dedication to our staff is evident in our comprehensive benefits package. We offer a very generous mixture of benefits, including many employer-paid options.
Health and Wellness:
Employer-paid comprehensive medical, pharmacy, and dental for employees
Vision insurance
Zero co-payments for employed physician office visits
Flexible Spending Account (FSA)
Employer-Paid Life Insurance
Employee Assistance Program (EAP)
Behavioral Health Services
Savings and Retirement:
401k Retirement Savings Plan
Income Protection Insurance
Other Benefits:
Vacation Time
Company celebrations
Employee Assistance Program
Employee Referral Bonus
Tuition Reimbursement
License Renewal CEU Cost Reimbursement Program
Business-casual working environment
Sick days
Paid holidays
Mileage
Employer will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of the LA City Fair Chance Initiative for Hiring Ordinance.Company Description
As one of the fastest growing Independent Physician Associations in Southern California, Regal Medical Group, Lakeside Community Healthcare & Affiliated Doctors of Orange County, offers a fast-paced, exciting, welcoming and supportive work environment. Opportunities abound, and enterprising, capable, focused people prosper with us. We promote teamwork, nurture learning, and encourage advancement for all of our employees. We want to see you excel, because we believe that your success is our success.