HEDIS Quality Senior/Manager in Chicago, IL

$80K - $100K(Ladders Estimates)

Meridian Health Plan   •  

Chicago, IL 60601

Industry: Finance & Insurance

  •  

5 - 7 years

Posted 46 days ago

This job is no longer available.

A Day in the Life of a Sr. Manager of Quality Data Abstraction:

This position works closely with the Director of Quality Improvement to provide oversight of the clinical data abstraction methodology for all State-specific LOBs, in order to achieve and maintain the quality and performance goals of Meridian Health Plan. This position supports the development of the State abstraction strategy and implements processes to improve Healthcare Effectiveness Data and Information Set (HEDIS), including medical record documentation, performance and data integrity. This position has responsibility for overseeing the company's strategic activities to ensure compliance with all State and accreditation reporting requirements.

Responsibilities

  • Lead operations and innovations around the quality improvement plan
  • Continually reassess and ensure compliance with all State regulatory requirements pertaining to the health plans quality improvement plan and program, including State performance and reporting measures
  • Serve as the health plans leader for HEDIS reporting and improvement initiatives, including the following:
  • Support the development of a comprehensive strategy for HEDIS improvement, including action plans for all key HEDIS measures
  • Support the contracting process through program design and measures and incentives design strategy
  • Oversight and management of the data abstraction process and enhancement of our provider partnerships for administrative and hybrid processes
  • Develop effective working relationships and efficient cross-functional processes with Medical Management, Utilization Management, Care Coordination, Network Development, Provider Relations, Customer Experience, Claims, Finance, Operations, and Information Technology
  • Participates as a subject matter expert (SME) in HEDIS planning activities including the Performance Improvement Committee and the annual HEDIS audits
  • Manages oversight of internal medical record databases, ensures appropriate training of all individuals entering clinical data into medical record databases, and monitors quality assurance processes
  • Mentors and trains new staff, such as Medical Record Review Abstractors and Clinical Data Reviewer
  • Works collaboratively to design and implement strategies for educating practitioners on effective HEDIS medical record documentation and compliance with established programs and guidelines
  • Makes recommendations for medical record chase logic, hybrid oversampling rates, technology enhancements, and reporting requirements
  • Engage a diverse set of external stakeholders beneficial to the continued growth and continuous improvement activities at MHP
  • Maintain strict confidentiality of employee and organizational information in accordance with HIPAA and State privacy regulations
  • Performs other duties as assigned

Qualifications

What you can bring to Meridian:

  • Bachelor's degree or Fellow Designation from the Academy of Healthcare Management (AHM) is required
  • Current license as a Registered Nurse or other health care professional license with appropriate training, as approved by the state, is preferred.
  • Master's degree in healthcare administration or related field is preferred.
  • At least five years of relevant experience involving medical record documentation, HEDIS, medical claims experience, or health care quality improvement
  • Previous experience in managed health care and Medicaid programs is required
  • Previous management and supervisory experience is required
  • Strong knowledge base of HEDIS Technical Standards and HEDIS Compliance Audit Standards
  • Working knowledge of CAHPS and NCQA, URAC or general accreditation requirements
  • Knowledge of claims and coding sets
  • Knowledge of continuous quality improvement strategies and practical application methodologies
  • Strong computer skills including competency in Microsoft Word, Excel, PowerPoint and managed care systems preferred
  • Strong analytical and data interpretation skills
  • Excellent organizational and project management skills
  • Excellent interpersonal and communication skills (written and verbal)
  • Ability to work in a collaborate team environment and analyze problems using a team approach
  • Ability to influence and manage a diverse set of stakeholders (clinical and nonclinical), both internally and externally
  • Ability to motivate others toward achievement of common goals
  • Ability to think creatively to resolve common barriers and issues
  • Ability to travel, primarily within the state of Illinois


Valid Through: 2019-10-1