HEDIS & Quality Principal Program Manager

About Advantmed

Advantmed is a leading provider of risk adjustment, quality improvement, and value-based solutions to health plans and providers. We drive market-leading performance with integrated technology, service, and program solutions that optimize the risk and quality performance of our partners. Our solutions focus on identifying, managing, and documenting risk and quality performance and the proactive clinical engagement of high acuity populations.

Job Summary

We are seeking a highly motivated and experienced individual to join our team as a HEDIS and Quality Program Manager. In this key role, you will be responsible for overseeing and managing all aspects of the Healthcare Effectiveness Data and Information Set (HEDIS) measures and quality improvement programs within our organization. Your expertise and leadership will contribute to enhancing the quality of care provided to our members and optimizing our performance on various quality metrics.

Responsibilities

1. HEDIS Management:

• Lead the planning, coordination, and execution of the annual HEDIS data collection, reporting, and submission process.
• Collaborate with cross-functional teams, including clinical, operations, and data analytics, to ensure accurate and timely data collection for HEDIS measures.
• Implement strategies to improve HEDIS measure performance and ensure compliance with national and regulatory standards.
• Focus on process improvement, change management, stakeholder engagement, program management and other processes that drive adoption and impact.

2. Quality Improvement:

• Develop and implement quality improvement initiatives to enhance overall healthcare quality and patient outcomes.
• Analyze and interpret HEDIS and other quality metrics data to identify areas for improvement and formulate action plans.
• Work closely with clinical teams to develop interventions and interventions aimed at addressing gaps in care and improving performance on quality measures.

3. Program Development and Oversight:

• Design, implement, and oversee quality programs that align with organizational goals and objectives. · Collaborate with internal stakeholders to develop policies, protocols, and guidelines to ensure the delivery of high-quality care.
• Monitor and evaluate the effectiveness of quality programs, making necessary adjustments based on performance data and industry best practices.

4. Data Management and Reporting:

• ·Manage the collection, analysis, and reporting of quality-related data, including HEDIS measures and other relevant quality metrics.
• Generate regular reports for internal and external stakeholders, highlighting performance, trends, and areas for improvement.
• Ensure data accuracy, integrity, and compliance with regulatory requirements.

5. Stakeholder Engagement:

• Foster strong relationships with internal teams, including operations and IT, to drive collaboration and alignment on quality improvement initiatives.
• Represent the organization in external forums, conferences, and collaborations related to quality measurement and improvement.

6. Continuous Education and Training:

• Stay current with industry trends, best practices, and regulatory changes related to HEDIS and quality improvement.
• Provide training and education to staff and stakeholders on quality-related topics, ensuring a culture of continuous improvement.
• Develop subject matter expertise on the Client Success team.

7. Client Success:

• Serves as a consultant for clients, and internal stakeholders, to design and deploy a successful customer strategy that is aligned with both regulatory requirements and the statement of work. · Manages day-to-day relationship with Advantmed client partners and ensures best in class service through oversight of client activities.
• Regularly channels client feedback regarding Advantmed performance, solutions and areas of improvement to internal Advantmed stakeholders.
• Build client strategy and account plans to guide the organization to ensure client satisfaction, contract retention, renewal, and revenue growth.

Requirements

Qualifications and Experience

• Minimum of 5 years of experience in healthcare quality improvement, with a focus on HEDIS
• Strong knowledge and understanding of HEDIS measures
• Experience managing and leading quality improvement initiatives
• Excellent project management skills, with the ability to prioritize tasks and meet deadlines
• Strong analytical skills with the ability to analyze and interpret quality data
• Excellent communication and interpersonal skills
• Ability to build and maintain relationships with internal and external stakeholders
• Proficient in Microsoft Office Suite

Benefits

• Health, Dental, Vision insurance after 30 days
• 401k
• PTO