Remote HEDIS Manager - Performance Improvement Opportunity

We are seeking a highly skilled and experienced HEDIS Manager - Performance Improvement to join our team at Presbyterian Healthcare Services. As a key member of our Performance Improvement Department, you will be responsible for managing the daily operations of HEDIS/Star Quality and Regulatory reporting, collaborating with various entities to drive organizational improvement efforts, and providing program management and subject matter expertise for complex analytics and reporting.

In this remote role, you will work closely with our Director of Performance Improvement, HEDIS contracted Vendor, and Analytics Operations department to ensure timely and accurate reporting, meeting accreditation and regulatory requirements, and performance measure targets. Your expertise will be instrumental in securing and maintaining an annual Medicare Advantage Star Rating of 4.0 or higher, meeting 100% of Medicaid Performance Measure targets, and ensuring the maintenance of NCQA health plan accreditation for all lines of business.

Responsibilities:

• Determine approach to securing and maintaining an annual Medicare Advantage Star Rating of 4.0 or higher and meeting 100% of Medicaid Performance Measure targets
• Provide direction, coordination, implementation, execution, and completion of HEDIS and Medicare Star programs
• Offer subject matter expertise in HEDIS and CMS STARS, ensuring continual performance improvement in QA/QI activities
• Promote PHS Quality strategies and compliance with policies, standards, and federal/state regulatory requirements

Requirements:

• Bachelor's degree in Business, Healthcare, or related field (Master's degree preferred)
• Minimum of 5 years in the healthcare/managed care industry with experience in HEDIS/Medicare Star performance measurement, analytics, reporting, and forecasting
• 2 years of prior supervisory or program/project manager experience
• Intermediate/advanced skills in Microsoft Office

What We Offer:

• Competitive compensation (up to $63.87/hour)
• Comprehensive benefits package, including medical, dental, vision, and more
• Wellness rewards program and opportunities for professional growth and development
• Remote work arrangement, with the option to work from home in the state of New Mexico

At Presbyterian Healthcare Services, we value diversity and inclusion, and we are committed to improving the health of our communities. If you are a motivated and experienced professional looking for a challenging and rewarding role, we encourage you to apply.

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