Talent.com
Manager HEDIS Program

Manager HEDIS Program

Martin's Point Health CarePortland, ME, US
30+ days ago
Job type
  • Full-time
Job description

Position Summary

The Manager, HEDIS Program educates and serves as the HEDIS subject matter expert (SME). The Manager, HEDIS Program is responsible for coordinating, implementing, and executing HEDIS Program specific projects, and ensuring consistency with company strategy, commitments, and goals. The HEDIS Administrator will assist with the communication of HEDIS results to internal and external stakeholders and coordinate efforts to drive improvements through quality improvement interventions (QIIs) projects (QIPs) across the health plan.

Job Description

Key Outcomes :

  • Manages the HEDIS Program including requirement gathering, creation of project plans and schedules, obtaining and managing resources, facilitating project execution, deployment, and closure.
  • Stays current with HEDIS guidelines and requirements, and best practices related to the execution of the HEDIS Roadmap.
  • Prepares accurate and timely reports on HEDIS performance for internal and external stakeholders, management, and regulatory bodies.
  • Maintains detailed project documentation in accordance with the NCQA HEDIS technical specifications, and HEDIS compliance audit standards, policies, and procedures.
  • Develops and implements strategies to validate supplemental data sources used in HEDIS operations, ensuring accuracy and reliability.
  • Works closely with vendors to ensure accuracy and validity of data obtained from external sources.
  • Creates and maintains a tracking system to document records of annual primary source verification activities, ensuring compliance with regulatory requirements.
  • Maintains a robust medical record review program to assess the quality of care provided by healthcare providers.
  • Develops and implements comprehensive auditing procedures to evaluate the accuracy and completeness of medical record documentation.
  • Analyzes medical record review findings and identifies opportunities for process improvement.
  • Manages the HEDIS team including coaching, professional growth and development, conducting performance evaluations and providing regular feedback to team members.

Education / Experience :

  • Bachelor's degree in health care or other related field; Master's Degree preferred
  • A minimum of five (5) years of experience in the health care industry, in HEDIS and / or quality improvement.
  • Experience in managed care health services environment.
  • Demonstrated knowledge of data collection, medical record review, and data extraction.
  • NCQA and HEDIS Experience.
  • Project management experience in a healthcare regulated or accredited environment.
  • Experience writing and editing regulatory policies and procedures as outlined by a governing body such as NCQA, TRICARE, or CMS.
  • Required License(s) and / or Certification(s) :

  • Active and unrestricted RN licensure.
  • Skills / Knowledge / Competencies (Behaviors) :

  • Demonstrates ability to manage teams and multi-disciplinary workgroups in achieving team objectives, without direct authority.
  • Ability to delegate responsibility, set priorities, and establish accountability.
  • Knowledge of CMS, DHA and NCQA quality programs.
  • Strong critical thinking, problem-solving and project management skills; ability to develop and implement solutions.
  • Ability to gather, interpret and present data to teams, senior leadership, and external partners.
  • Possesses ability to interpret and simplify communications of regulatory standards and remain up to date on changes to requirements.
  • Maintains broad knowledge of industry trends and developments.
  • Proactive approach and able to work independently, highly organized.
  • Excellent written and oral communication skills, able to discuss negative events with others in a supportive and non-punitive manner.
  • Ability to build collaborative relationships with multi-disciplinary teams supporting the achievement of objectives, without direct authority.
  • Inspires others toward the goal of continuous quality and safety improvement.
  • Manages multiple competing demands, able to prioritize and make sound decisions.
  • Competence with computers and business applications : Microsoft Outlook, Excel, Word, and Power Point.
  • Demonstrates understanding of and alignment with Martin's Point values.
  • There are additional competencies linked to individual contributor, provider, and leadership roles. Please consult with your leader to discuss additional competencies that are relevant to your position.

    This position is not eligible for immigration sponsorship.

    We are an equal opportunity / affirmative action employer.

    Create a job alert for this search

    Program Manager • Portland, ME, US

    Related jobs
    • Promoted
    Licensed Mental Health Counselor

    Licensed Mental Health Counselor

    HeadwayNE, United States
    Full-time
    Licensed Mental Health Counselor (LMHC).Wage : Between $120-$131 an hour.Licensed Mental Health Counselor — Are you ready to launch or expand your private practice? . Headway is here to help you star...Show moreLast updated: 30+ days ago
    • Promoted
    Travel Emergency Department Registered Nurse

    Travel Emergency Department Registered Nurse

    CrossMedBridgton, ME, US
    Full-time
    CrossMed is seeking a travel nurse RN ED - Emergency Department for a travel nursing job in Bridgton, Maine.Job Description & Requirements. At CrossMed Healthcare Staffing, we aim to create last...Show moreLast updated: 30+ days ago
    • Promoted
    Travel Nurse RN - Progressive Care Unit - $1,853 to $2,006 per week in Bridgton, ME

    Travel Nurse RN - Progressive Care Unit - $1,853 to $2,006 per week in Bridgton, ME

    TravelNurseSourceBridgton, ME, US
    Full-time
    TravelNurseSource is working with Host Healthcare to find a qualified PCU RN in Bridgton, Maine, 04009!.Host Healthcare is an award-winning travel healthcare company with an immediate opening for t...Show moreLast updated: 4 days ago
    • Promoted
    Travel Nurse RN - Behavioral Health - $1,966 per week in Lewiston, ME

    Travel Nurse RN - Behavioral Health - $1,966 per week in Lewiston, ME

    TravelNurseSourceLewiston, Maine, US
    Full-time
    TravelNurseSource is working with GetMed Staffing to find a qualified Behavioral Health RN in Lewiston, Maine, 04243!.GetMed Staffing is searching for a strong Psych / Behavioral Health RN to assist ...Show moreLast updated: 4 days ago
    • Promoted
    Travel Nurse RN - Long-Term Care - $1,943 to $2,043 per week in Lewiston, ME

    Travel Nurse RN - Long-Term Care - $1,943 to $2,043 per week in Lewiston, ME

    TravelNurseSourceLewiston, ME, US
    Full-time +1
    TravelNurseSource is working with Converdia Health Staffing to find a qualified Long-Term Care RN in Lewiston, Maine, 04240!. ConVerdia Health Staffing- Staffing temporary and permanent jobs across ...Show moreLast updated: 20 days ago
    • Promoted
    Licensed Behavioral Health Therapist-Telehealth Only

    Licensed Behavioral Health Therapist-Telehealth Only

    LifeStance HealthBailey Island, ME, US
    Full-time
    At LifeStance Health, we believe in a truly healthy society where mental and physical healthcare are unified to make lives better. Our mission is to help people lead healthier, more fulfilling lives...Show moreLast updated: 30+ days ago
    • Promoted
    Travel Registered Nurse - Progressive Care Unit - $1,853 to $2,006 per week in Bridgton, ME

    Travel Registered Nurse - Progressive Care Unit - $1,853 to $2,006 per week in Bridgton, ME

    TravelNurseSourceBridgton, ME, US
    Full-time
    TravelNurseSource is working with Host Healthcare to find a qualified PCU RN in Bridgton, Maine, 04009!.Host Healthcare is an award-winning travel healthcare company with an immediate opening for t...Show moreLast updated: 4 days ago
    • Promoted
    Travel Nurse - RN - ER - Emergency Room - $1897.2 / Week

    Travel Nurse - RN - ER - Emergency Room - $1897.2 / Week

    CrossMed HealthcareBridgton, ME, US
    Full-time
    CrossMed Healthcare is seeking an experienced Emergency Room Registered Nurse for an exciting Travel Nursing job in Bridgton, ME. Shift : 12 hr days Start Date : 10 / 15 / 2025 Duration : 13 weeks Pay : $18...Show moreLast updated: 6 days ago
    • Promoted
    Licensed Mental Health Therapist

    Licensed Mental Health Therapist

    LifeStance HealthCornish, ME, US
    Full-time
    At LifeStance Health, we believe in a truly healthy society where mental and physical healthcare are unified to make lives better. Our mission is to help people lead healthier, more fulfilling lives...Show moreLast updated: 30+ days ago
    • Promoted
    Travel Nurse RN - Long-Term Care - $1,845 per week in Lewiston, ME

    Travel Nurse RN - Long-Term Care - $1,845 per week in Lewiston, ME

    TravelNurseSourceLewiston, ME, US
    Full-time +1
    TravelNurseSource is working with Infojini Healthcare to find a qualified Long-Term Care RN in Lewiston, Maine, 04240!.Self Assessment (Skills Checklist). At Infojini Healthcare, We tell it like it ...Show moreLast updated: 30+ days ago
    • Promoted
    Travel Nurse RN - ED - Emergency Department

    Travel Nurse RN - ED - Emergency Department

    Go HealthcareLewiston, ME, US
    Full-time
    Go Healthcare is seeking a travel nurse RN ED - Emergency Department for a travel nursing job in Lewiston, Maine.Job Description & Requirements. Pay package is based on 12 hour shifts and 36 hou...Show moreLast updated: 30+ days ago
    • Promoted
    Travel Nurse RN - ED - Emergency Department

    Travel Nurse RN - ED - Emergency Department

    Slate HealthcareLewiston, ME, US
    Full-time
    Slate Healthcare is seeking a travel nurse RN ED - Emergency Department for a travel nursing job in Lewiston, Maine.Job Description & Requirements. Profession : RN, JobSpecialty : ED ER, Shift : 3x12 ...Show moreLast updated: 30+ days ago
    • Promoted
    Travel Emergency Department RN

    Travel Emergency Department RN

    CrossMedBridgton, ME, US
    Full-time
    CrossMed is seeking a travel nurse RN ED - Emergency Department for a travel nursing job in Bridgton, Maine.Job Description & Requirements. At CrossMed Healthcare Staffing, we aim to create last...Show moreLast updated: 30+ days ago
    • Promoted
    Principal Program Manager - Aerospace and Defense

    Principal Program Manager - Aerospace and Defense

    1014 AD FederalElizabeth, MA, United States
    Full-time +1
    NASDAQ : ADI ) is a global semiconductor leader that bridges the physical and digital worlds to enable breakthroughs at the Intelligent Edge. ADI combines analog, digital, and software technologie...Show moreLast updated: 6 days ago
    • Promoted
    Licensed Mental Health Therapist

    Licensed Mental Health Therapist

    HeadwayNE, United States
    Full-time
    Licensed Mental Health Therapist (LMHT).Wage : Between $120-$131 an hour.Licensed Mental Health Therapist — Are you ready to launch or expand your private practice? . Headway is here to help you star...Show moreLast updated: 30+ days ago
    • Promoted
    Travel Nurse RN - Labor & Delivery - $3,905 per week in Biddeford, ME

    Travel Nurse RN - Labor & Delivery - $3,905 per week in Biddeford, ME

    TravelNurseSourceBiddeford, ME, US
    Full-time
    TravelNurseSource is working with Advantis Medical Staffing to find a qualified Labor / Delivery RN in Biddeford, Maine, 04005!. Advantis Medical, the #1 rated travel nurse agency, is currently seekin...Show moreLast updated: 4 days ago
    • Promoted
    Licensed Psychiatric Mental Health Nurse Practitioner

    Licensed Psychiatric Mental Health Nurse Practitioner

    HeadwayNE, United States
    Full-time
    Licensed Psychiatric Nurse Practitioner.Wage : Between $89-$203 an hour.Did you know that you can build a flexible private practice on your terms as a psychiatric nurse practitioner?.Whether you wan...Show moreLast updated: 30+ days ago
    • Promoted
    Travel CT Tech - $2,565 to $2,744 per week in Bridgton, ME

    Travel CT Tech - $2,565 to $2,744 per week in Bridgton, ME

    AlliedTravelCareersBridgton, ME, US
    Full-time
    AlliedTravelCareers is working with Host Healthcare to find a qualified CT Tech in Bridgton, Maine, 04009!.Host Healthcare is an award-winning travel healthcare company with an immediate opening fo...Show moreLast updated: 30+ days ago