HEDIS® Project Manager

Location: Philadelphia, PA
Date Posted: 12-31-2018
HEDIS Project Manager - Health Plan
Philadelphia, PA
*** Full Time, Benefits Available, CONTRACT opportunity, expected to last 6-12 months! ***
** Offers a mix of Work From Home (80%) and in Corporate Offices (20%)! **

HEDIS Project Manager Job Summary:
  • Leads planning, analysis, development, reporting and submission of HEDIS and other mandatory reports to regulators or accreditors.
  • Provides project leadership to develop annual HEDIS project plan, and monitor progress and timeliness.
  • Coordinate completion of HEDIS roadmap in conjunction with related initiatives and mandates.
  • Ensure compliance with HEDIS technical specifications, policies, operating procedures, and goals in compliance with internal and external guidelines.
  • Monitor project progress and timeliness to ensure deadlines are met.
  • Provide timely HEDIS measure status reporting, including trending and analyzing of the data.
  • Define objectives, processing requirements and specifications to document steps taken and results achieved related to HEDIS results
  • Able to conduct data extraction from source systems for validation and analysis.
  • Manages and validates HEDIS data, assures data integrity and reporting.
  • Acts in the role of clinical subject matter expert for all matters related to HEDIS requirements.
  • Serve as a primary HEDIS contact for client inquiries and sales process.
  • Develop training manual annually and other educational materials.
  • Effectively oversees external vendor performance related to medical record data collections. 
  • Accurately assess data, identify opportunities and facilitate cross-departmental prioritization of rate improvement quality work.
  • Collaborate with departments to design, implement and monitor effectiveness of interventions.
  • Provide comprehensive analysis of HEDIS measures, barriers, and opportunities and present results of improvement efforts and ongoing performance measures to senior management.
  • Creates and makes formal presentations of trending reports throughout HEDIS cycle to keep executive management apprised of current status. 
  • Participate in the HEDIS post mortem analysis to increase rates and evaluate and analyze annual HEDIS rates.
  • Develop and respond to HEDIS Audit Corrective Action Plan (CAP) as necessary; and develop work plan for tracking of the HEDIS Quality Improvement Intervention Measures.
  • Development and execution of HEDIS intervention steps to improve targeted measures.
  • Assist in coordinating new enhancements, including system enhancements and report generation, to improve HEDIS scores.
HEDIS Project Manager Background: 
  • Bachelor of Science in Nursing, Business or Healthcare Administration, Analytics, or related field is required.
  • Around 3-5 combined years of prior recent HEDIS experience, including roles such as data collection, over-reading, project management, etc.
  • Roughly 1-3 years of Project Management experience, preferably related to HEDIS, Quality Improvement or other accreditation surveys.
  • At least 2-3 years’ experience in a Managed Care Organization (Health Plan/HMO/MSO/TPA/IPA/etc).
  • Ability to manage multiple, complex projects with strict HEDIS deadlines.
  • Strong knowledge of health care related coding and/or STAR ratings is a plus.
  • Thorough understanding of statistics, data analytics, modeling, reporting methods and data mining methodologies.
  • Resourcefulness as demonstrated by the effective application of professional knowledge to new situations. Possess planning, organizing, conflict resolution, negotiating and interpersonal skills.
  • Experience in training / teaching staffs to meet operational requirements and goals.
  • Strong oral and written communication skills; ability to interact with all levels of internal and external contacts.
  • Strong analytical mind, with problem solving and investigative skills, an aptitude for accuracy, and attention to detail.
  • Must be computer literate and knowledgeable in MS Office, E-mail and EMR systems, and multiple additional programs including word processing, and data management.
  • Possess superior verbal and written communication skills, able to interface with business and medical professionals.


® “HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA)."
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